155 NATURE OF MEDICATION ERRORS OF OMISSION IDENTIFIED THROUGH SOLICITED REPORTS BY ATTENDING PHYSICIANS IN AN ACADEMIC MEDICAL CENTER.

Abstract Context.—Text reports convey critical medical information from pathologists, radiologists, and subspecialty consultants. These reports must be clear and comprehensible to avoid medical errors. Pathologists have paid much attention to report completeness but have ignored the corresponding issue of report comprehension. This situation presents an increasingly serious potential problem. As laboratories are consolidated and as reports are disseminated in new ways (eg, via the World Wide Web), the target audience becomes more diverse and less likely to have any contact with pathologists beyond the written reports themselves. Objective.—To compare clinician comprehension with pathologist intent in written pathology reports. Methods.—Typical surgical pathology reports relevant to surgeons and covering a range of specimen complexity were taken from our hospital files. Questionnaires based on these cases were administered open-book-examination style to surgical attending physicians and trainees during surgical conferences at an academic medical center. Main Outcome Measures.—Scores from questionnaires. Results.—Surgeons misunderstood pathologists' reports 30% of the time. Surgical experience reduced but did not eliminate the problem. Streamlined report formatting exacerbated the problem. Conclusions.—A communication gap exists between pathologists and surgeons. Familiarity with report format and clinical experience help reduce this gap. Paradoxically, stylistic improvements to report formatting can interfere with comprehension and increase the number of misunderstandings. Further investigation is required to reduce the number of misunderstandings and, thus, medical errors.

Download Full-text

The Procedure Coordinator: A Resident-Driven Initiative to Increase Opportunity for Inpatient Procedures

Journal of Graduate Medical Education ◽

10.4300/jgme-d-18-00399.1 ◽

2018 ◽

Vol 10 (5) ◽

pp. 583-586 ◽

Cited By ~ 2

Author(s):

Matthew Gorgone ◽

Brian McNichols ◽

Valerie J. Lang ◽

William Novak ◽

Alec B. O'Connor

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Medical Providers ◽

Procedural Training ◽

Academic Medical ◽

Attending Physician ◽

Attending Physicians ◽

The Impact ◽

Training Opportunities

ABSTRACT Background Training residents to become competent in common bedside procedures can be challenging. Some hospitals have attending physician–led procedure teams with oversight of all procedures to improve procedural training, but these teams require significant resources to establish and maintain. Objective We sought to improve resident procedural training by implementing a resident-run procedure team without routine attending involvement. Methods We created the role of a resident procedure coordinator (RPC). Interested residents on less time-intensive rotations voluntarily served as RPC. Medical providers in the hospital contacted the RPC through a designated pager when a bedside procedure was needed. A structured credentialing process, using direct observation and a procedure-specific checklist, was developed to determine residents' competence for completing procedures independently. Checklists were developed by the residency program and approved by institutional subspecialists. The service was implemented in June 2016 at an 850-bed academic medical center with 70 internal medicine and 32 medicine-pediatrics residents. The procedure service functioned without routine attending involvement. The impact was evaluated through resident procedure logs and surveys of residents and attending physicians. Results Compared with preimplementation procedure logs, there were substantial increases postimplementation in resident-performed procedures and the number of residents credentialed in paracenteses, thoracenteses, and lumbar punctures. Fifty-nine of 102 (58%) residents responded to the survey, with 42 (71%) reporting the initiative increased their ability to obtain procedural experience. Thirty-one of 36 (86%) attending respondents reported preferentially using the service. Conclusions The RPC model increased resident procedural training opportunities using a structured sign-off process and an operationalized service.

Download Full-text

Evaluation of Perioperative Medication Errors and Adverse Drug Events

Anesthesiology ◽

10.1097/aln.0000000000000904 ◽

2016 ◽

Vol 124 (1) ◽

pp. 25-34 ◽

Cited By ~ 110

Author(s):

Karen C. Nanji ◽

Amit Patel ◽

Sofia Shaikh ◽

Diane L. Seger ◽

David W. Bates

Keyword(s):

Medication Errors ◽

Adverse Drug Events ◽

Medical Center ◽

Academic Medical Center ◽

Tertiary Care ◽

Academic Medical ◽

Study Staff ◽

Chart Abstraction ◽

Life Threatening ◽

Perioperative Medication

Abstract Background The purpose of this study is to assess the rates of perioperative medication errors (MEs) and adverse drug events (ADEs) as percentages of medication administrations, to evaluate their root causes, and to formulate targeted solutions to prevent them. Methods In this prospective observational study, anesthesia-trained study staff (anesthesiologists/nurse anesthetists) observed randomly selected operations at a 1,046-bed tertiary care academic medical center to identify MEs and ADEs over 8 months. Retrospective chart abstraction was performed to flag events that were missed by observation. All events subsequently underwent review by two independent reviewers. Primary outcomes were the incidence of MEs and ADEs. Results A total of 277 operations were observed with 3,671 medication administrations of which 193 (5.3%; 95% CI, 4.5 to 6.0) involved a ME and/or ADE. Of these, 153 (79.3%) were preventable and 40 (20.7%) were nonpreventable. The events included 153 (79.3%) errors and 91 (47.2%) ADEs. Although 32 (20.9%) of the errors had little potential for harm, 51 (33.3%) led to an observed ADE and an additional 70 (45.8%) had the potential for patient harm. Of the 153 errors, 99 (64.7%) were serious, 51 (33.3%) were significant, and 3 (2.0%) were life-threatening. Conclusions One in 20 perioperative medication administrations included an ME and/or ADE. More than one third of the MEs led to observed ADEs, and the remaining two thirds had the potential for harm. These rates are markedly higher than those reported by retrospective surveys. Specific solutions exist that have the potential to decrease the incidence of perioperative MEs.

Download Full-text

Medication errors during medical emergencies in a large, tertiary care, academic medical center

Resuscitation ◽

10.1016/j.resuscitation.2011.10.001 ◽

2012 ◽

Vol 83 (4) ◽

pp. 482-487 ◽

Cited By ~ 15

Author(s):

Roman Gokhman ◽

Amy L. Seybert ◽

Paul Phrampus ◽

Joseph Darby ◽

Sandra L. Kane-Gill

Keyword(s):

Medication Errors ◽

Medical Center ◽

Academic Medical Center ◽

Tertiary Care ◽

Academic Medical ◽

Large Tertiary Care ◽

Medical Emergencies

Download Full-text

Implementation of a medical student-run telemedicine program for medications for opioid use disorder during the COVID-19 pandemic

Harm Reduction Journal ◽

10.1186/s12954-020-00438-4 ◽

2020 ◽

Vol 17 (1) ◽

Author(s):

Marcus Castillo ◽

Brianna Conte ◽

Sam Hinkes ◽

Megan Mathew ◽

C. J. Na ◽

...

Keyword(s):

Medical Student ◽

People Who Inject Drugs ◽

Medical Center ◽

Academic Medical Center ◽

Opioid Use Disorder ◽

Health Issues ◽

Opioid Use ◽

Academic Medical ◽

Life Saving ◽

Attending Physicians

Abstract Objectives The COVID-19 pandemic led to the closure of the IDEA syringe services program medical student-run free clinic in Miami, Florida. In an effort to continue to serve the community of people who inject drugs and practice compassionate and non-judgmental care, the students transitioned the clinic to a model of TeleMOUD (medications for opioid use disorder). We describe development and implementation of a medical student-run telemedicine clinic through an academic medical center-operated syringe services program. Methods Students advertised TeleMOUD services at the syringe service program on social media and created an online sign-up form. They coordinated appointments and interviewed patients by phone or videoconference where they assessed patients for opioid use disorder. Supervising attending physicians also interviewed patients and prescribed buprenorphine when appropriate. Students assisted patients in obtaining medication from the pharmacy and provided support and guidance during home buprenorphine induction. Results Over the first 9 weeks in operation, 31 appointments were requested, and 22 initial telehealth appointments were completed by a team of students and attending physicians. Fifteen appointments were for MOUD and 7 for other health issues. All patients seeking MOUD were prescribed buprenorphine and 12/15 successfully picked up medications from the pharmacy. The mean time between appointment request and prescription pick-up was 9.5 days. Conclusions TeleMOUD is feasible and successful in providing people who inject drugs with low barrier access to life-saving MOUD during the COVID-19 pandemic. This model also provided medical students with experience treating addiction during a time when they were restricted from most clinical activities.

Download Full-text

Interns' Experiences of Disruptive Behavior in an Academic Medical Center

Journal of Graduate Medical Education ◽

10.4300/jgme-d-12-00025.1 ◽

2013 ◽

Vol 5 (1) ◽

pp. 25-30 ◽

Cited By ~ 16

Author(s):

Charles P. Mullan ◽

Jo Shapiro ◽

Graham T. McMahon

Keyword(s):

Disruptive Behavior ◽

Medical Center ◽

Academic Medical Center ◽

Hospital Environment ◽

First Year ◽

Convenience Sample ◽

Team Members ◽

Academic Medical ◽

And Gender ◽

Attending Physicians

Abstract Background The first year of graduate medical education is an important period in the professional development of physicians. Disruptive behavior interferes with safe and effective clinical practice. Objective To determine the frequency and nature of disruptive behavior perceived by interns and attending physicians in a teaching hospital environment. Method All 516 interns at Partners HealthCare (Boston, MA) during the 2010 and 2011 academic years were eligible to complete an anonymous questionnaire. A convenience nonrandom sample of 40 attending physicians also participated. Results A total of 394 of 516 eligible interns (76.4%) participated. Attendings and interns each reported that their team members generally behaved professionally (87.5% versus 80.4%, respectively). A significantly greater proportion of attendings than interns felt respected at work (90.0% versus 71.5% respectively; P = .01). Disruptive behavior was experienced by 93% of interns; 54% reported that they experienced it once a month or more. Interns reported disruptive behavior significantly more frequently than attending physicians, including increased reports of condescending behavior (odds ratio [OR], 5.46 for interns compared with attendings; P < .001), exclusion from decision making (OR, 6.97; P < .001), and berating (OR, 4.84; P = .02). Inappropriate jokes, abusive language, and gender bias were also reported, and they were not significantly more frequent among interns than attending physicians. Interns most frequently identified nurses as the source of disruption, and were significantly more likely than faculty to identify nurses as the source of disruptive behavior (OR, 10.40; P < .001). Attendings reported other physicians as the most frequent source of disruption. Conclusions Although interns generally feel respected at work, they frequently experience disruptive behavior. Interns described more disruptive behaviors than a convenience sample of attending physicians at our institution.

Download Full-text

Communication about opioid versus nonopioid analgesics in the emergency department

Journal of Opioid Management ◽

10.5055/jom.2015.0271 ◽

2015 ◽

Vol 11 (3) ◽

pp. 229 ◽

Cited By ~ 14

Author(s):

Danielle M. McCarthy, MD, MS ◽

Kenzie A. Cameron, PhD, MPH ◽

D. Mark Courtney, MD, MS ◽

James G. Adams, MD ◽

Kirsten G. Engel, MD

Keyword(s):

Emergency Department ◽

Adverse Effects ◽

Medical Center ◽

Academic Medical Center ◽

Multivariable Analysis ◽

Secondary Analysis ◽

Academic Medical ◽

Frequency Of Use ◽

Nonopioid Analgesics ◽

Attending Physicians

Objective: The Medication Communication Index (MCI) was used to compare counseling about opioids to nonopioid analgesics in the Emergency Department (ED) setting.Design: Secondary analysis of prospectively collected audio recordings of ED patient visits.Setting: Urban, academic medical center (>85,000 annual patient visits). Participants: Patient participants aged >18 years with one of four low acuity diagnoses: ankle sprain, back pain, head injury, and laceration. ED clinician participants included resident and attending physicians, nursing staff, and ED technicians.Main outcome measures: The MCI is a five-point index that assigns points for communicating the following: medication name (1), purpose (1), duration (1), adverse effects (1), number of tablets (0.5), and frequency of use (0.5). Recording transcripts were scored with the MCI, and total scores were compared between drug classes.Results: The 41 patients received 56 prescriptions (27 nonopioids, 29 opioids). Nonopioid median MCI score was 3 and opioid score was 4.5 (p = 0.0008). Patients were counseled equally about name (nonopioid 100 percent, opioid 96.6 percent, p = 0.34) and purpose (88.9 percent, 89.7 percent, p = 0.93). However, patients receiving opioids were counseled more frequently about duration of use (nonopioid 40.7 percent, opioid 69.0 percent, p = 0.03) and adverse effects (18.5 percent, 93.1 percent, p < 0.001). In multivariable analysis, opioids (β = 0.54, p = 0.04), number of medications prescribed (β = −0.49, p = 0.05), and time spent in the ED (β = 0.007, p = 0.006) were all predictors of total MCI score.Conclusions: The extent of counseling about analgesic medications in the ED differs by drug class. When counseling patients about all analgesic medications, providers should address not only medication name and purpose but also the less frequently covered topics of medication dosing, timing, and adverse effects.

Download Full-text

Abstract 406: Are Providers Overconfident in Predicting Outcome After Cardiac Arrest?

Circulation ◽

10.1161/circ.140.suppl_2.406 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Alexis Steinberg ◽

Clifton W Callaway ◽

Cameron Dezfulian ◽

Jonathan Elmer

Keyword(s):

Cardiac Arrest ◽

Medical Center ◽

Academic Medical Center ◽

Favourable Outcome ◽

Academic Medical ◽

Predicting Outcome ◽

Using Data ◽

And Function ◽

Future Work ◽

Attending Physicians

Objective: Prognostication after cardiac arrest is challenging. We tested if providers’ confidence in their neuroprognostic assessments correlates with accuracy. Methods: We presented physicians with clinical synopses using data from real-time, post-arrest patients being treated at a single academic medical center. We allowed providers to ask for any additional data available at the time the assessment was performed. We asked providers: (1) will the patient survive to hospital discharge?; (2) will the patient have favourable function at discharge?; and, (3) their confidence in each prediction (0-100%). We repeated assessments daily until death or post-arrest day 5. Results: We completed 414 assessments of 51 patients with 59 providers. Of patients, 79% died, 8% were discharged with unfavourable function and 12% had functionally favourable survival. Providers accurately predicted survival in 257/414 (62%) assessments. In most errors (136/141, 96%), providers predicted survival in a patient who died. Providers accurately predicted function in 282/414 (68%) assessments. In most errors (125/132, 95%), providers incorrectly predicted a favourable outcome. Providers were confident in their assessments (median confidence predicting survival 80 [IQR 60 - 90]; median confidence predicting function 80 [IQR 60 - 95]). Accuracy predicting survival and function were both positively correlated with confidence (both P<0.001), but confidence explained only 7% and 15% of observed variance in accuracy, respectively. When providers reported 100% confidence predicting survival, they were correct in 31/42 (74%) cases. Accuracy did not vary over time. Attending physicians were not more accurate than trainees predicting survival (65% vs 60% accurate) and were less accurate prediciting functional outcome (62% vs 84% accurate, P< 0.001). Confidence did not differ between attendings and trainees. Conclusions: Providers were overly optimistic predicting outcomes at discharge. Self-reported confidence explained only a small percentage of variance in accuracy. Even when extremely confident, providers were often wrong. Our future work will explore patient and provider factors that contribute to error.

Download Full-text