Complications: acknowledging, managing, and coping with human error

Errors and omissions: Incomplete or incorrect documentation on admission to inpatient rehabilitation

BACKGROUND

As patients move from acute to postacute care settings, clinicians rely on complete and accurate documentation. Errors or omissions during transitions in care expose patients to physical harm, may result in lower institutional quality metrics, expose institutions to medicolegal risk, and may contribute to provider burnout.

OBJECTIVE

To identify the frequency and types of errors encountered in discharge paperwork from acute care hospitals for patients being admitted to an acute inpatient rehabilitation facility.

DESIGN

Cohort study.

SETTING

Tertiary freestanding acute inpatient rehabilitation facility.

PATIENTS/PARTICIPANTS

The primary admitting provider in two 1-month study periods 1 year apart was sent an electronic survey for each admission completed to identify the presence of a documentation error. Providers were asked to characterize the type of error including the name(s) of medication(s) involved, if applicable.

MAIN OUTCOME MEASURES

Presence of an error or omission in discharge paperwork, the type of error, and any medication(s) involved in medication errors.

RESULTS

Errors in discharge paperwork were noted in 58 (30.4%) unique admissions out of 191 completed surveys in August 2021 and in 42 (23.2%) unique admissions out of 194 completed surveys in August 2022. Medication errors were most commonly encountered (61.0% and 70.5% of all errors, respectively). Less common errors involved code status, weightbearing status, and bracing instructions, among others.

CONCLUSIONS

High rates of documentation errors predominantly involving medications were noted during both study periods, which expose patients to the risk of physical harm, jeopardize hospital quality metrics, and expose institutions and providers to medicolegal risk. The presence of such errors requires heightened clinician vigilance to identify and remedy, which may lead to higher levels of provider stress and burnout. Collaboration with acute care hospitals is necessary to further reduce documented rates of errors in discharge paperwork in this systems-level challenge.

How to Manage Complications and Poor Outcomes

Complications and poor outcomes are an inevitable part of sports medicine surgery. When building a practice, dealing with complications can be overwhelming and difficult to overcome. Establishing strong and transparent surgeon-patient relationships built on open communication and realistic expectations is fundamental to preemptive management of poor outcomes. When a complication occurs, careful action and appropriate treatment are imperative to ensure the best possible outcome. Patients who trust their surgeons are less likely to pursue medicolegal action. A complication can lead to self-doubt, anxiety, and depression. Surgeons should seek counsel from colleagues when dealing with complications and learn from their mistakes.

Advanced repair of recurrent and low-large hysterotomy defects using a myometrial glide flap

BACKGROUND

The resolution of factors linked to the recurrence of cesarean section defects can be accomplished through a comprehensive technique that effectively addresses the dehiscent area, eliminates associated intraluminal fibrosis, and establishes a vascularized anterior wall by creating a sliding myometrial flap.

OBJECTIVE

Propose a comprehensive surgical repair for recurrent and large low hysterotomy defects in women seeking pregnancy or recurrent spotting.

STUDY DESIGN

A retrospective cohort analysis included 54 patients aged 25-41 with recurrent large cesarean scar defects treated at Otamendi, CEMIC, and Valle de Lili hospitals. Comprehensive surgical repair was performed by suprapubic laparotomy, involving a wide opening of the vesicouterine space, removal of the dehiscent cesarean scar and all intrauterine abnormal fibrous tissues, using a glide myometrial flap, and intramyometrial injection of autologous platelet-rich plasma. Qualitative variables were determined, and descriptive statistics were employed to analyze the data in absolute frequencies or percentages. The data obtained were processed using the InfostatTM statistic program.

RESULTS

Following the repair, all women experienced normal menstrual cycles and demonstrated an adequate lower uterine segment thickness, with no evidence of healing defects. All patients experienced early ambulation and were discharged within 24 h. Uterine hemostasis was achieved at specific points, minimizing the use of electrocautery. The standard duration of the procedure was 60 min (skin-to-skin), and the average bleeding was 80-100 ml. No perioperative complications were recorded. A control T2-weighted MRI was performed six months after surgery. All patients displayed a clean, unobstructed endometrial cavity with a thick anterior wall (Median: 14.98 mm, IQR 13-17). Twelve patients became pregnant again, all delivered by cesarean between 36.1 and 38.0 weeks, with a mean of 37.17 weeks. The thickness of the uterine segment before cesarean ranged between 3 and 7 mm, with a mean of 3.91 mm. No cases of placenta previa, dehiscence, placenta accreta spectrum (PAS), or postpartum hemorrhage were reported.

CONCLUSIONS

The comprehensive repair of recurrent low-large defects offers a holistic solution for addressing recurrent hysterotomy defects. Innovative repair concepts effectively address the wound defect and associated fibrosis, ensuring an appropriate myometrial thickness through a gliding myometrial flap.

Psychometric Properties of Chinese Version of the Barriers to Error Disclosure Assessment (C-BEDA) Tool

Aim

The Barriers to Error Disclosure Assessment (BEDA) tool is used to measure barriers to the disclosure of medical errors by healthcare professionals. This study aimed to evaluate the psychometric properties of the Chinese version of the BEDA (C-BEDA).

Background

The culture of disclosure and transparency in response to medical errors has been recommended in recent years. However, there are no relevant assessment tools for measuring barriers to disclosing medical errors in China.

Methods

The C-BEDA tool underwent translation, back translation, cross-cultural adaptation in a pilot study. It was tested with 1254 healthcare professionals in Guizhou and Sichuan Provinces, China. The content validity index (CVI) was used to evaluate the content validity of the C-BEDA, and exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to evaluate its structural validity. The Cronbach's α coefficient and test-retest reliability were evaluated to determine its reliability.

Results

Three factors were extracted by EFA that explained 65.892% of the total variance of the C-BEDA tool. CFA showed a good fit for a three-factor structure with acceptable values: goodness-of-fit index=0.939; adjusted goodness-of-fit index=0.911; incremental fit index=0.967; comparative fit index=0.967; partial least squares path modeling for confirmatory factor analysis=0.735; and root mean square error of approximation=0.058. The item-level content validity index ranged from 0.86 to 1.00, and the average scale-level content validity index was 0.98. The Cronbach's α coefficient (0.909) and test-retest reliability (0.86) were acceptable.

Conclusion

The C-BEDA toolis a valid and reliable tool for assessing the extent of barriers to error disclosure among Chinese healthcare professionals.

Psychological, physical, and professional impact on second victims in veterinary anaesthesia: a cross-sectional international survey - Part 1

OBJECTIVE

To investigate the psychological, physical and professional impact of veterinary patient safety incidents (PSIs) on veterinary anaesthesia professionals.

STUDY DESIGN

We conducted an observational cross-sectional survey, inviting veterinary anaesthesiologists, anaesthesiologists in training and veterinary nurses/technicians through social media platforms from 2 June 2023 to 20 September, 2023. The questionnaire was based on Second Victim Experience and Support Survey (SVEST) and analysed using descriptive statistics and subscale scoring to assess psychological, physical and professional impacts.

RESULTS

A total of 303 participants from 31 countries responded, including North (24%), Central (13.5%) and South America (25%), Europe (13.5%), UK (12.5%), Australia/New Zealand (8.1%) and Asia/Middle East (3.3%). A participation rate cannot be estimated. All respondents described themselves as second victims, with 70% encountering a PSI in the past 6 months. Of the 303 participants, 75% had direct involvement with the incident. Common post-incident challenges included an increased awareness for PSIs (67.1%), fear of new PSIs (62.7%), diminished confidence (56.1%), more defensive medicine practice (46.7%) and sleep disorders (43.3%). Additionally, 62.7% agreed or strongly agreed that they experienced embarrassment post-incident. After a PSI, approximately 69% of the participants reported feeling inadequate in their animal care abilities, and a similar percentage questioned their professional competence. Over half of the respondents (54.6%) became fearful of undertaking high-risk procedures. Approximately 38% of respondents considered leaving the field of anaesthesia, and over 56% harboured thoughts of leaving their job because of the stress from PSIs. Additionally, a significant proportion (69.8%) reported not taking time off work following PSIs.

CONCLUSIONS AND CLINICAL RELEVANCE

The study identifies a significant psychological, physical and professional impact on the surveyed veterinary anaesthesia professionals, with notable effects on their emotional well-being and professional self-efficacy. The findings emphasize the need for supportive measures and interventions to mitigate the adverse effects experienced by these individuals.

Beyond the operating room: addressing the "second-victim" phenomenon in surgical practice

Complications are plausible events during surgical operations. Surgical complications profoundly impact surgeons, often called "second victims" of adverse events. These complications trigger a range of emotional and psychological responses, including guilt, anxiety, heightened empathy, and the looming threat of burnout. Moreover, the toll extends to physical health, with chronic stress and sleep disturbances taking their toll. Surgeons' social lives are not immune to the fallout, and their career satisfaction may wane, pushing some towards defensive medicine practices. While mentorship, counselling, and peer support are crucial support mechanisms, they encounter barriers such as time constraints and the fear of negative perceptions. This paper suggests practical recommendations, including comprehensive wellness programmes, a streamlined badge card system for easy access to resources, and mindfulness training to mitigate stress and burnout. Recognising and proactively addressing these multifaceted impacts is imperative for cultivating a resilient medical community capable of providing optimal patient care.

Exploring patient perspectives: orthognathic surgery outcomes and experiences assessed by patient-reported outcome measures and patient-reported experience measures

Evaluating the effectiveness of orthognathic treatment can be difficult. To address this issue, patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) have been proposed as valuable instruments for understanding the quality of healthcare from the patients' standpoint. Therefore, the aim of this project was to employ PROMs and PREMs questionnaires to capture the patients' perspectives regarding their experience during the orthognathic treatment process, as well as their perception of their postoperative state. Preoperative and postoperative questionnaires were offered to patients at consenting appointment and at various timepoints after the surgery. The assessment of statistical relationships was carried out by means of Fisher's exact test. A total of 64 preoperative and 126 postoperative responses were received. The primary motivators for pursuing the surgery were the improvement of facial and dental aesthetics, as well as increased satisfaction with photographic and video appearances. These three factors were also cited as the most important postoperative benefits. Of the respondents, 58% reported experiencing altered sensation to the lower lip at the 24-month follow up (p = 0.02); however, the affected patients reported that this did not have an impact on their daily activities. The use of PROMs and PREMs to appraise the quality of life constitutes a valuable method for surgeons to gauge their treatment efficacy. Above all, such tools are particularly useful for evaluating patient satisfaction, which is the ultimate objective of any treatment.

Psychosocial impact of surgical complications and the coping mechanisms among surgeons in Uganda and Eastern Democratic Republic of the Congo

We aimed to assess the psychosocial impact from postoperative complications on the surgical workforce and the coping mechanisms they use following these complications in Uganda and Eastern Democratic Republic of the Congo (DRC). This was a cross-sectional multi-center study conducted from first February 2022 to 31st March 2022 in the preselected main teaching hospitals of Uganda and Eastern DRC. We surveyed the surgical workforce (practicing surgeons, Obstetrician-Gynecologists, and residents in surgery/ Obstetrics-Gynecology) who had experienced postoperative complications in their career. Data was analysed using SPSS version 23. One hundred ninety-eight participants responded to the questionnaire. Worry about patient and reputation were the commonest psychological impacts in 54.0% and 45.5% of the participants respectively. Majority of the participants (55.1%) used positive coping mechanisms with a positive impact on their practice (94.4%). Being a female doctor (AOR = 2.637, CI 1.065-6.533, P = 0.036), worrying about reputation (AOR = 3.057, CI = 1.573-5.939, P = 0.001) and guilt after a complication (AOR = 4.417, CI = 2.253-8.659, P = <0.001) were predictors of a negative coping mechanism. Postoperative surgical complications continue to cause a huge psychological impact on the operating doctors in Uganda and the Eastern DRC. Female doctors, those that worry about the reputation and those that feel guilty following a complication should be given more support and guidance by peers when surgical complications occur to their patients.

Dealing with complications in interventional radiology

It is widely accepted that most misadventures, which lead to harm have not occurred because of a single individual but rather due to a failure of process that results in healthcare workers making mistakes. This failure of process and the pervasiveness of adverse events is just as prevalent in Interventional Radiology (IR) as it is in other specialities. The true prevalence and prevailing aetiology of complications in IR are not exactly known as there is a paucity of investigative literature into this area; especially when compared with other more established disciplines such as Surgery. Some IR procedures have a higher risk profile than others. However, published data suggests that many adverse events in IR are preventable (55-84%) and frequently involve a device related complication such as improper usage or malfunction. This article aims to discuss factors that contribute to complications in IR along with tools and strategies for dealing with them to achieve optimal patient outcomes.

The prevention and management of postoperative trachomatous trichiasis: A systematic review

Among ocular infections, trachoma is the main cause of blindness. Repeated conjunctival Chlamydia trachomatis infections lead to trichiasis, corneal opacification, and visual impairment. Surgery is often needed to relieve discomfort and preserve vision; however, a high postoperative trachomatous trichiasis (PTT) rate has been observed in various settings. We wanted to know why, whether PTT rates could be reduced, and how to manage the PTT that occurs. We performed a search of the literature. Of 217 papers screened, 59 studies were identified for inclusion as potentially relevant, the majority having been excluded for not directly concerning PTT in humans. Preventing PTT is a major challenge. Only one published trial, the STAR trial in Ethiopia, has reported a cumulative PTT rate <10% one year after surgery. The literature on the management of PTT is sparse. Though no PTT management guidelines are available, high-quality surgery with a low rate of unfavorable outcomes for PTT patients is likely to require enhanced training of a smaller group of highly-skilled surgeons. Based on the surgical complexity and the authors' own experience, the pathway for patients suffering from PTT should be studied further for improvement.

Prescription Precision: A Comprehensive Review of Intelligent Prescription Systems

Intelligent Prescription Systems (IPS) represent a promising frontier in healthcare, offering the potential to optimize medication selection, dosing, and monitoring tailored to individual patient needs. This comprehensive review explores the current landscape of IPS, encompassing various technological approaches, applications, benefits, and challenges. IPS leverages advanced computational algorithms, machine learning techniques, and big data analytics to analyze patient-specific factors, such as medical history, genetic makeup, biomarkers, and lifestyle variables. By integrating this information with evidence-based guidelines, clinical decision support systems, and real-time patient data, IPS generates personalized treatment recommendations that enhance therapeutic outcomes while minimizing adverse effects and drug interactions. Key components of IPS include predictive modeling, drug-drug interaction detection, adverse event prediction, dose optimization, and medication adherence monitoring. These systems offer clinicians invaluable decision-support tools to navigate the complexities of medication management, particularly in the context of polypharmacy and chronic disease management. While IPS holds immense promise for improving patient care and reducing healthcare costs, several challenges must be addressed. These include data privacy and security concerns, interoperability issues, integration with existing electronic health record systems, and clinician adoption barriers. Additionally, the regulatory landscape surrounding IPS requires clarification to ensure compliance with evolving healthcare regulations. Despite these challenges, the rapid advancements in artificial intelligence, data analytics, and digital health technologies are driving the continued evolution and adoption of IPS. As precision medicine gains momentum, IPS is poised to play a central role in revolutionizing medication management, ultimately leading to more effective, personalized, and patient-centric healthcare delivery.

Medical competence as a multilayered construct

BACKGROUND

The conceptualisation of medical competence is central to its use in competency-based medical education. Calls for 'fixed standards' with 'flexible pathways', recommended in recent reports, require competence to be well defined. Making competence explicit and measurable has, however, been difficult, in part due to a tension between the need for standardisation and the acknowledgment that medical professionals must also be valued as unique individuals. To address these conflicting demands, a multilayered conceptualisation of competence is proposed, with implications for the definition of standards and approaches to assessment.

THE MODEL

Three layers are elaborated. This first is a core layer of canonical knowledge and skill, 'that, which every professional should possess', independent of the context of practice. The second layer is context-dependent knowledge, skill, and attitude, visible through practice in health care. The third layer of personalised competence includes personal skills, interests, habits and convictions, integrated with one's personality. This layer, discussed with reference to Vygotsky's concept of Perezhivanie, cognitive load theory, self-determination theory and Maslow's 'self-actualisation', may be regarded as the art of medicine. We propose that fully matured professional competence requires all three layers, but that the assessment of each layer is different.

IMPLICATIONS

The assessment of canonical knowledge and skills (Layer 1) can be approached with classical psychometric conditions, that is, similar tests, circumstances and criteria for all. Context-dependent medical competence (Layer 2) must be assessed differently, because conditions of assessment across candidates cannot be standardised. Here, multiple sources of information must be merged and intersubjective expert agreement should ground decisions about progression and level of clinical autonomy of trainees. Competence as the art of medicine (Layer 3) cannot be standardised and should not be assessed with the purpose of permission to practice. The pursuit of personal excellence in this level, however, can be recognised and rewarded.

Implementation of a Brief Evidence-Based Intraoperative Coping Curriculum

BACKGROUND AND RATIONALE

Recent research has called for further resident training in coping with errors and adverse events in the operating room. To the best of our knowledge, there currently exists no evidence-based curriculum or training on this topic.

MATERIALS AND METHODS

Synthesizing three prior studies on how experienced surgeons react to errors and adverse events, we developed the STOPS framework for handling surgical errors and adverse events (Stop, Talk to your team, Obtain help, Plan, Succeed). This material was presented to residents in two teaching sessions.

RESULTS AND CONCLUSION

In this paper, we describe the presentation of, and the uniformly positive resident reaction to, the STOPS framework: an empirically based psychological tool for surgeons who experience operative errors or adverse events.

Risk Management-Obstetrics and Gynecology Perspective

The Obstetrics and Gynecology physician's likelihood to experience medical malpractice claims are higher than in other medical specialties. We will review the basic principles of health care risk management, the role of the risk manager, and the importance of health care risk management in risk mitigation for obstetrics and gynecology physicians. Attention is focused on medical record documentation, disclosure of adverse events, second victim programs, grievance management techniques, alternative dispute resolution concepts, regulatory inquiries including state licensure investigations, product failures, and electronic media strategies. Concluding, health care risk management may be used as a claim avoidance tool and provider protective vehicle for physicians.

Complications and treatment errors in periodontal and implant therapy

The assortment of periodontal and implant-related treatments has been continuously improved over the last 50 years. Once the decision-making process has been established and the treatment procedure applied, the partial or complete resolution of the problem (eg, periodontal probing depth reduction, clinical attachment level gain, gingival recession reduction, dental hypersensitivity decrease) and a diagnosis change with no or minimal occurrence of adverse events (ie, complications, harms, technical errors, or adverse/side effects) can be expected. The clear identification of the potential types of adverse effects, complications, or even errors is important for contemporary decision-making processes, as they may be related to different local, systemic, and technical aspects. This chapter focused on four core components: (a) providing periodontal definitions for errors, complications, harms, and side effects; (b) defining the types of risk and the clinical impact of adverse effects, errors, and complications in periodontal and peri-implant therapies; (c) evaluating the influence of accidental errors versus the lack of a proper treatment planning; and (d) reporting on the importance of establishing the "net benefit ratio" between the clinical improvements promoted by the therapy and the occurrence of potential adverse events.

Complications of diagnostic upper Gastrointestinal endoscopy: common and rare - recognition, assessment and management

A clear understanding of the potential complications or adverse events (AEs) of diagnostic endoscopy is an essential component of being an endoscopist. Creating a culture of safety and prevention of AEs should be part of routine endoscopy practice. Appropriate patient selection for procedures, informed consent, periprocedure risk assessments and a team approach, all contribute to reducing AEs. Early recognition, prompt management and transparent communication with patients are essential for the holistic and optimal management of AEs. In this review, we discuss the complications of diagnostic upper gastrointestinal endoscopy, including their recognition, treatment and prevention.

Negative emotions experienced by healthcare staff following medication administration errors: a descriptive study using text-mining and content analysis of incident data

BACKGROUND

Medication errors regardless of the degree of patient harm can have a negative emotional impact on the healthcare staff involved. The potential for self-victimization of healthcare staff following medication errors can add to the moral distress of healthcare staff. The stigma associated with errors and their disclosure often haunts healthcare professionals, leading them to question their own professional competence. This paper investigates the negative emotions expressed by healthcare staff in their reported medication administration error incidents along with the immediate responses they received from their seniors and colleagues after the incident.

METHOD

This is a retrospective study using a qualitative descriptive design and text mining. This study includes free-text descriptions of medication administration error incidents (n = 72,390) reported to National Reporting & Learning System in 2016 from England and Wales. Text-mining by SAS text miner and content analysis was used to analyse the data.

RESULTS

Analysis of data led to the extraction of 93 initial codes and two categories i.e., 1) negative emotions expressed by healthcare staff which included 4 sub-categories of feelings: (i) fear; (ii) disturbed; (iii) sadness; (iv) guilt and 2) Immediate response from seniors and colleagues which included 2 sub-categories: (i) Reassurance and support and (ii) Guidance on what to do after an error.

CONCLUSION

Negative emotions expressed by healthcare staff when reporting medication errors could be a catalyst for learning and system change. However, negative emotions when internalized as fear, guilt, or self-blame, could have a negative impact on the mental health of individuals concerned, reporting culture, and opportunities for learning from the error. Findings from this study, hence, call for future research to investigate the impact of negative emotions on healthcare staff well-being and identify ways to mitigate these in practice.

Leadership behaviors, attitudes and characteristics to support a culture of safety

It has been estimated that medical errors are the third highest-ranking cause of death in the United States. A patient safety culture has been touted for many years as best practice to reduce medical error. While there is a general agreement of its importance, it has remained elusive for many. This study sought to learn how strengthening leadership skills within a health care organization could catalyze patient safety culture improvement. The research asked the following to gain an appreciation for that question: How does a leader ensure consistency in policies, practices, and protocols to create a patient safety culture? What attitudes, beliefs, and collective efficacy are needed to produce a patient safety culture? What leadership characteristics are needed to create a patient safety culture? The research participants were the employees who make up the patient safety department in a large academic health care system. Information was gathered to capture their view of leadership's role in patient safety culture and to gain knowledge relative to their individual experiences following a medical error.

STOPS: A Coping Framework for Surgeons Who Experience Intraoperative Error

OBJECTIVE

To investigate the steps faculty surgeons take upon experiencing intraoperative error and synthesize these actions to offer a framework for coping with errors.

BACKGROUND

While intraoperative errors are inevitable, formal training in error recovery is insufficient and there are no established curricula that teach surgeons how to deal with the intraoperative error. This is problematic because insufficient error recovery is detrimental to both patient outcomes and surgeon psychological well-being.

METHODS

We conducted a thematic analysis. One-hour in-depth semistructured interviews were conducted with faculty surgeons from 3 hospitals. Surgeons described recent experiences with intraoperative error. Interviews were transcribed and coded. Analysis allowed for development of themes regarding responses to errors and coping strategies.

RESULTS

Twenty-seven surgeons (30% female) participated. Upon completion of the analysis, themes emerged in 3 distinct areas: (1) Exigency, or a need for training surgical learners how to cope with intraoperative errors, (2) Learning, or how faculty surgeons themselves learned to cope with intraoperative errors, and (3) Responses, or how surgeons now handle intraoperative errors. The latter category was organized into the STOPS framework: Intraoperative errors could produce STOPS: Stop, Talk to your Team, Obtain Help, Plan, Succeed.

CONCLUSIONS AND RELEVANCE

This study provides both novel insight into how surgeons cope with intraoperative errors and a framework that may be of great use to trainees and faculty alike.

Speaking with Frankenstein

This collaborative essay experimentally applies the insights of Mary Shelley's 1818 gothic fantasy Frankenstein to clinical interactions between present-day physicians and the patients they, akin to Shelley's human protagonist, so often seem to bring (back) to life. Because that process is frequently fraught with unspoken elements of ambivalence, disappointment, frustration, and failure, we find in Shelley's speculative fiction less a cautionary tale of overreach than a dynamic parable of the role that the unspoken, the invisible, and the unknown might play in contemporary physician/patient relationships. Playing with that parable, we consider its relevance to four often unacknowledged dynamics that shape physician/patient interaction: commitment to a false binary of life and death; the tyranny of normative aesthetics; shared negative affect; and the ethics of care and care-denial. To "speak with Frankenstein" is, we show, to make space for the otherwise unspeakable. The result is a more complete model of narrative medicine that accommodates to its ideal of open communication and full attention the persistence of what cannot be said, seen, or known--only imagined and approximated.

Surgeons' Perspectives on Intraoperative Gray Area Surgical Complications of Cataract Surgery

PURPOSE

To explore surgeons' perspectives and practice patterns in regards to "gray area" surgical complications (GASCs) within cataract surgery.

SETTING

Tertiary care academic referral center.

DESIGN

Retrospective observational cross-sectional study.

METHODS

An anonymous, online survey consisting of 11 potential intraoperative GASC scenarios was developed and distributed to practicing and resident ophthalmologists in the United States. Demographic data such as gender, experience and practice settings were recorded. Using a Likert scale, respondents scaled their perception of likelihood that a GASC could lead to post-operative complications, as well as their obligation towards patient disclosure and documentation in the operative report. Respondents also scaled their likelihood of agreement with a series of statements inserted to assess baseline anxiety levels and inherent perspectives regarding disclosure.

RESULTS

A total of 389 responses were analyzed. Female surgeons were more likely than male surgeons to disclose GASCs to their patients and experience psychological anxiety with regard to patient outcomes. Both early- and late-stage residents were more likely to believe that GASCs could lead to vision-limiting outcomes as compared to attending surgeons. Surgeons at academic centers were more likely than community-based surgeons to disclose GASCs in the operative report and experience psychological anxiety in regards to patient outcomes.

CONCLUSIONS

Significant differences based on gender, practice setting, and level of experience exist in regards to disclosure and documentation of intraoperative GASCs. Additional studies are needed to further explore reasons for these differences, as reporting patterns may have an impact on patient satisfaction, medico-legal risks, and postoperative surgeon-experienced anxiety.

Surgeon's guilt after postoperative complication

Surgery is an art, surgical dilemmas are not mathematical problems with rigid, straight cut solutions and the human mind/body is not a perfect science. In such a scenario, unexpected, sudden complications can happen during surgery. While better diagnostic and advanced techniques in surgery, have minimised surgical errors to a great extent, with the risk of post-operative death being as low as 3.6% now, still when complications due occur, the surgeon faces a huge backlash not only from the patient relatives, but from his peers, the hospital management, the social and print media. The surgeon also fears violent retribution, not just consumer issues but a threat of arrest and legal battles. All these make a surgeon the "second victim" in the event of a post-operative complication, leading to changes in practice behaviour, emotional turmoil and even serious mental issues like depression and suicide. In this era of instant judgement by a largely unregulated social media, it is urgently required to address this issue and provide appropriate strength/support to the surgical fraternity.

Medication error awareness among health care providers in Palestine: a questionnaire based cross-sectional observational study

Background

Increased awareness among healthcare professionals regarding medication errors and the establishment of a medication error reporting system can significantly reduce the prevalence of medication errors. Unfortunately, Palestine lacks a regulatory system for the control, reporting, and education of medication errors.

Objectives

This study aimed to assess the awareness of medication errors and reporting of medication errors in the Palestinian medical community.

Methods

A cross-sectional observational study was conducted using a self-administered survey involving doctors, nurses, and pharmacists in Palestine. The survey consisted of 20 questions to assess healthcare providers' awareness and course of actions related to medication errors. Data were collected from February 2020 to April 2020. Statistical Package for the Social Sciences (SPSS) was used for data analysis. This study was approved by the ethical committee of Birzeit University.

Results

A total of 394 participants were included, including 202 nurses, 114 doctors, and 78 pharmacists. 203 (51.5%) had a good awareness level of medication errors, whereas 126 (32%) and 65 (16.5%) had average awareness and poor awareness levels, respectively. In addition, 66.0% of providers did not inform the patients after recognizing the error. Fear of legal or social consequences and being too busy are significant barriers to reporting medication errors. Moreover, 35 % of all providers were not aware of the reporting system in their institutions or the reporting methodology, and only 26% of all participants confirmed that their institutions provided continuous education on medication errors.

Conclusion

This study revealed differences in healthcare professionals' awareness of medication errors. The study's findings emphasize the urgent need to adopt appropriate measures to raise awareness about medication errors among healthcare providers in Palestine. Furthermore, establishing a regulatory policy and a national medication error reporting system to improve medication safety.

Are patients knowledgeable of medical errors and medical complications? A cross-sectional study at a tertiary hospital, Riyadh

Background

Basic understanding of medical errors and medical complications is essential to ensure patient safety. Our aim in this study was to assess whether patients have sufficient knowledge of medical errors and medical complications and to identify the factors that influence their knowledge.

Methods

A cross-sectional study was conducted with 400 patients with a scheduled appointment at King Abdulaziz Medical City from 2019 to 2020. A self-administered validated questionnaire was developed by the coinvestigators. The first section focused on demographic information, and the second contained 17 scenarios to assess the knowledge of the patients. The data were analyzed with Chi-square test and logistic regression.

Results

The sample size realized as 346 (n = 346), with the majority (n = 198, 57%) female, and the mean age 39.5 ± 11 years. The mean scores for the medical errors and complications were 5.5 ± 2.10 and 4.8 ± 2.3, respectively. The participants with secondary education were less likely to have sufficient knowledge of both medical complications (OR 0.52, P = 0.016) and errors (OR 0.52, P = 0.016). In terms of age, the older participants, the 38-47 year age group, were less likely to be knowledgeable about medical complications compared to the younger age groups (OR 0.92, P = 0.046).

Conclusion

The patients had a higher level of knowledge about medical errors compared to medical complications. The level of education and the employment status significantly predicted the knowledge of both medical errors and complications.

The Medical Malpractice Deposition: A Review for Radiologist Defendants

Please see the Editorial Comment by David M. Yousem discussing this article. Depositions are critical components of any medical malpractice lawsuit and seek to help uncover the facts of the case, to allow justice to be served. Depositions often create considerable anxiety for physician defendants, including radiologists. Defendants unfamiliar with the rules of questioning, or interviewing techniques, used by plaintiff attorneys may fail to appreciate important and nuanced details of the plaintiff attorney's questions, which in turn could impact the outcome of the case. Thorough and informed deposition preparation is thus essential. Highlighting issues relevant to radiologist defendants, we discuss the role and structure of medical malpractice depositions as well as common scenarios, lines of questioning, and attorney strategies.

A cross-sectional survey on nurses' second victim experience and quality of support resources in Singapore

AIM

The study aimed to investigate nurses' second victim experience and quality of support resources in Singapore.

BACKGROUND

The second victim phenomenon, broadly described as the suffering of providers including nurses in the face of a clinical error, is often overlooked.

METHODS

A cross-sectional questionnaire survey was adopted. A total of 1,163 nurses from an acute public hospital in Singapore took part in the study. The Second Victim Experience and Support Tool (SVEST) was employed to assess experience of second victims and the quality of support resources.

RESULTS

The study results showed that nurses experienced second victim-related physical, psychological and professional distress. About 31.8% of the participants had turnover intentions, while 9.3% had absenteeism following an error. Nurses who are younger and less experienced were more likely to experience greater second victim response. Among the support options, peer support was rated as the most desirable.

CONCLUSION

Nurses, being at the forefront of care delivery, are especially susceptible to being a casualty of the second victim phenomenon.

IMPLICATIONS FOR NURSING MANAGEMENT

Acknowledging the second victim phenomenon, together with a strong organizational support, is essential in alleviating the trauma and assisting nurses with reconciliation in the aftermath of an unanticipated error.

Medication errors in the care transition of trauma patients

RATIONALE, AIMS, AND OBJECTIVE

Traumatological patients are vulnerable to medication error given multiple handoffs throughout the hospital since they often require rapid diagnosis and management of multiple concurrent complex conditions. The purpose of this study was to analyze the medication errors (MEs) occurring in the care transition of the traumatological patient. The secondary objectives were to classify the MEs and the level of risk of the pharmacological groups involved. In addition, the causes and contributing factors of those MEs were analyzed.

METHODS

An observational, descriptive, and prospective study, spanning 4 months, was performed in a tertiary hospital. All patients admitted to the traumatology service were selected for the study. Data were collected in different locations of the hospital stay: Emergency Service, Resuscitation and Post-Anaesthesia Unit, and Traumatology Hospitalization Unit. In each location, data from the different processes (reconciliation, prescription, validation, dispensing, and administration of medicines) were collected. The medication error (ME) was established as a dependent variable.

RESULTS

A total of 31.3% (132) of the patients analyzed showed some ME. The Traumatology Unit was the location where most errors were detected, followed by the Emergency Service. Having analyzed all the locations, it was observed that 64.2% (172) of the MEs were detected in the reconciliation process, 29.5% (79) in the prescription, 3.7% (10) in the dispensing, 1.5% (4) in the administration, and 1.1% (3) in the validation. In terms of risk weighting, the drugs involved in the MEs detected were 53.8% of medium risk, 20.7% of high risk, and 20.3% of low risk.

CONCLUSIONS

There is a high prevalence of MEs in the reconciliation process of medication in traumatological patients (64.2%) from our hospital setting. Interestingly, most MEs occurred in this process regardless of the location in the healthcare chain.

Morbidity and mortality meetings to improve patient safety: a survey of 109 consultant surgeons in London, United Kingdom

Background

Morbidity & Mortality (M&M) meetings are a critical component of clinical governance. They have the potential to improve patient outcomes, quality of care, attitudes towards patient safety and they contribute to the education of clinical staff. This study aimed to evaluate individual surgeons’ experience of these meetings, and to explore their perceived usefulness and barriers to open discussion of adverse outcomes.

Methods

Consultant general surgeons in London, United Kingdom, were invited to anonymously complete an online survey consisting of 18 key items.

Results

Invitations were sent to 323 consultant surgeons from 19 NHS Trusts. Responses were received from 109 (33.7%), of which 99 (90.8%) answered all key items. Seventy-two of 104 (69.2%) attend almost all or all M&M meetings. These were rated as being more conducive for learning than for service improvement (p = 0.001). On a scale of 1 to 10 (10 = fearless), 41 of 105 (39.0%) rated as ≤5 the fearfulness of legal or other negative repercussions resulting from open discussion of complications/mortalities. Ninety-eight respondents gave a median rating of 10 (IQR: 8–10) for willingness to talk openly about their complications/mortalities (10 = willing/able).

Conclusions

Many surgeons in London do not routinely attend M&M meetings, despite these occurring within ‘protected time’. There may be a willingness to talk openly about complications, though there exists a fear of litigation. The nature, content and learning potential of such open M&M discussions should be explored in future research.