1 Medical Errors and Patient Safety for Medical Educators Joseph L. Halbach, M.D., M.P.H. Associate Professor and Chairman Department of Family Medicine New York Medical College New York Medical College/Saint Joseph’s Medical Center Department of Family Medicine

2 Medical Errors/Patient Safety I.Why is this topic important for Medical Educators? II.What is currently being taught and who is teaching it? III.What do we recommend should be taught – and how? New York Medical College/Saint Joseph’s Medical Center Department of Family Medicine

3 I. Why is this topic important for medical educators? Medical Errors/Patient Safety New York Medical College/Saint Joseph’s Medical Center Department of Family Medicine

4 Medical Errors/Patient Safety Because this topic has rapidly become “HOT” since the “IOM Report”, embraced by the media, government, industry, and private groups. But less rapidly by many physicians. New York Medical College/Saint Joseph’s Medical Center Department of Family Medicine

5 Pre-1999 Hilfiker, D “Facing our Mistakes” NEJM 1984 Harvard Medical Practice Study 1991 Medical Errors/Patient Safety New York Medical College/Saint Joseph’s Medical Center Department of Family Medicine

6 Medical Errors/Patient Safety Pre-1999 Anesthesia Patient Safety Foundation The Mid 1990’s Incidents New York Medical College/Saint Joseph’s Medical Center Department of Family Medicine

7 The IOM Report NOV 1999 (The Institute of Medicine of the National Academy of Sciences) 44,000 – 98,000 deaths annually in US hospitals due to error. Medical Errors/Patient Safety New York Medical College/Saint Joseph’s Medical Center Department of Family Medicine

8 Post – IOM: The Patient Safety Movement Media Government Industry Professional Associations Joint Commission Medical Literature Medical Errors/Patient Safety New York Medical College/Saint Joseph’s Medical Center Department of Family Medicine

9 GOVERNMENT  Agency for Healthcare Research and Quality – (AHRQ) July 2001 “Making Healthcare Safer: A Critical Analysis of Patient Safety Practices” October $50 Million grant funding Medical Errors/Patient Safety New York Medical College/Saint Joseph’s Medical Center Department of Family Medicine

10 INDUSTRY  The Leapfrog Group Require hospitals to adopt computerized physician order entry. Steer patients to hospitals/doctors with high volume of high-risk procedures. Require ICUs to be staffed with critical care specialists. Medical Errors/Patient Safety New York Medical College/Saint Joseph’s Medical Center Department of Family Medicine

11 Professional Associations National Patient Safety Foundation (AMA) National Center for Patient Safety (VA) Institute for Healthcare Improvement (funding from RWJ) National Quality Forum (NQF) Many organizations devoted to medication errors. Britain, Australia, Canada and other countries have similar powerful movements. Medical Errors/Patient Safety New York Medical College/Saint Joseph’s Medical Center Department of Family Medicine

12 INSTITUTIONS Joint Commission July 2001: New Standards for Hospitals in effect Leadership must create a culture of safety. Implementation of patient safety programs. Prevent errors through analysis and re-design of vulnerable systems. Responsibility to disclose to patient/family if harmed by care provided. Medical Errors/Patient Safety New York Medical College/Saint Joseph’s Medical Center Department of Family Medicine

13 JCAHO National Patient Safety Goals 2003 and Improve Patient Identification 2.Improve communication among caregivers 3.Improve Safety of high-alert medications 4.Eliminate wrong-site, wrong-patient, wrong-procedure surgery 5.Improve safety of Infusion Pumps 6.Improve clinical alarm systems 7.Reduce Healthcare – acquired infections Error in Medicine New York Medical College Department of Family Medicine

14 Medical Errors/Patient Safety Literature New York Medical College/Saint Joseph’s Medical Center Department of Family Medicine Articles on Medical Error/Patient Safety in Refereed Journals by year of publication (as of 4/15/02).

15 Medical Literature Entire Issues devoted to the topic: - BMJ – Feb Acad Emer Med –November J Law Med & Ethics – Fall/Winter Academic Medicine – October 2002 Medical Errors/Patient Safety New York Medical College/Saint Joseph’s Medical Center Department of Family Medicine

16  Medical students and residents see errors made, make errors, do not see them discussed, and are greatly affected by medical errors.  Acculturation and moral development of medical students and residents starts early.  Future physicians need knowledge, skills and attitude to prevent and/or handle errors.  Residents can help identify and report errors. Medical Errors/Patient Safety Literature New York Medical College/Saint Joseph’s Medical Center Department of Family Medicine

17 II. What is currently being taught and who is teaching it? Published Literature on educating students and residents. Medical Errors/Patient Safety New York Medical College/Saint Joseph’s Medical Center Department of Family Medicine

18  We found 4 curricula Literature on Predoctoral Medical Education described in published literature, 2 in the US.  We located brief references to unpublished curricula from 16 other schools.  Occurring in all years, mostly via lecture/discussion or panels; many as part of the Medical Ethics or Introduction to Clinical Medicine courses. Medical Errors/Patient Safety Medical Schools New York Medical College/Saint Joseph’s Medical Center Department of Family Medicine

19 No published literature was found on educating about medical errors in Family Practice Residencies. Medical Errors/Patient Safety Family Practice Residencies New York Medical College/Saint Joseph’s Medical Center Department of Family Medicine

20 Medical Errors/Patient Safety III.Recommendations for Teaching 5 Major Content Areas New York Medical College/Saint Joseph’s Medical Center Department of Family Medicine

21 Medical Errors/Patient Safety Recommended Content Areas 1. Epidemiology of medical error (the Numbers) -Sources of the data. -Inpatient vs outpatient -Common types of error -High risk settings New York Medical College/Saint Joseph’s Medical Center Department of Family Medicine

22 Medical Errors/Patient Safety Recommended Content Areas 2. Ethical, Professional, Legal Issues and the “Culture of Medicine” -Honestly as a core value -Obligations to patients -Threat of malpractice -“Blame and shame” culture -System errors vs bad apples New York Medical College/Saint Joseph’s Medical Center Department of Family Medicine

23 Medical Errors/Patient Safety Recommended Content Areas 3. How to respond to a Medical Error -Identity and remedy error -Report -Disclose -Document -Analyze -Heal New York Medical College/Saint Joseph’s Medical Center Department of Family Medicine

24 Medical Errors/Patient Safety Recommended Content Areas 4. Effects on the physician (“the second victim”) -common reactions to making an error -coping mechanisms -need for support vs the current climate -importance of self-awareness New York Medical College/Saint Joseph’s Medical Center Department of Family Medicine

25 Recommended Content Areas 5. Prevention of Medical Errors -Design of systems to prevent or “absorb” errors -“Safety sciences” especially Human Factors Engineering -Teamwork Training and Communication -Technology (e.g. CPOE) Medical Errors/Patient Safety New York Medical College/Saint Joseph’s Medical Center Department of Family Medicine

26 Teaching Methods  Small group discussions to get at feelings about this topic  More effective with third year students than preclinical students. Medical Errors/Patient Safety New York Medical College/Saint Joseph’s Medical Center Department of Family Medicine

27 Teaching Methods  Participation of faculty, residents, students in the Institution’s Quality and Safety Meetings.  Role Modeling by Attendings of error reporting and disclosure  Simulations (e.g. use of standardized patient with whom an error must be discussed)  Work to increase discussion of medical error and patient safety in our specialty Medical Errors/Patient Safety

28 Components of NYMC Curriculum  Didactic Session  Required Readings  Videotape/Feedback Session Started in July 2000 Medical Errors/Patient Safety New York Medical College/Saint Joseph’s Medical Center Department of Family Medicine

29 Feedback and other Ideas Medical Errors/Patient Safety New York Medical College/Saint Joseph’s Medical Center Department of Family Medicine