Narrowing the mindware gap in medicine

Diagnosis ◽  
2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Pat Croskerry
Keyword(s):  
United States ◽  
Cognitive Performance ◽  
Clinical Reasoning ◽  
Medical Errors ◽  
Medical Error ◽  
Causes Of Death ◽  
The United States ◽  
Morbidity And Mortality ◽  
Medical Educators ◽  
High Degree

Abstract Medical error is now recognized as one of the leading causes of death in the United States. Of the medical errors, diagnostic failure appears to be the dominant contributor, failing in a significant number of cases, and associated with a high degree of morbidity and mortality. One of the significant contributors to diagnostic failure is the cognitive performance of the provider, how they think and decide about the process of diagnosis. This thinking deficit in clinical reasoning, referred to as a mindware gap, deserves the attention of medical educators. A variety of specific approaches are outlined here that have the potential to close the gap.

Disclosure of Error in the Intensive Care Unit

2018 ◽  
Author(s):  
Leslie Hale ◽  
Katrina Kirksey Harper ◽  
Anna Bovill Shapiro
Keyword(s):  
United States ◽  
Patient Care ◽  
Medical Errors ◽  
Medical Error ◽  
Hospital Costs ◽  
The United States ◽  
Target System ◽  
Treatment Providers ◽  
Prolonged Hospital ◽  
The Impact

Each year, as many as 98,000 hospital deaths in the United States can be attributed to medical error. Considering that at least half of all medical errors go unreported, the impact they have on mortality, morbidity, prolonged hospital stay, rising hospital costs, and the doctor-patient relationship cannot be overemphasized. At the heart of the dilemma are patients and their family members, who rely on clinicians to provide optimal medical care, devoid of mistakes and error, and want an apology if an error has taken place. In this review, we discuss the moral obligation of hospitals to disclose medical error, no matter what the impact. Whereas in the past, a paternalistic approach to medicine viewed this acknowledgment as weakness, there is now a consensus to advocate for full disclosure, apology, and discussions that facilitate early disclosure of error using teams representing administration, patient care liaisons, and treatment providers. Many institutions now recognize that medical errors are commonly the result of a breakdown of checks and balances, and an increasing number are implementing protocols that target system errors to prevent similar future occurrences. We examine institutions across the United States that take a proactive approach by assembling “communication and resolution” programs to address the concerns of patients and their families through the process of disclosure. We also explore barriers to disclosure, which are attributed to lack of training, fear of litigation, and the “shame and blame culture.” We discuss the benefit, to both patient and provider, of disclosure of accountability as we move toward a culture of strengthening systems and improving patient care and patient-provider relationships. Key words: apology, culture, disclosure, error, resolution

Disclosure of Error in the Intensive Care Unit

2017 ◽  
Author(s):  
Leslie Hale ◽  
Katrina Kirksey Harper ◽  
Anna Bovill Shapiro
Keyword(s):  
United States ◽  
Patient Care ◽  
Medical Errors ◽  
Medical Error ◽  
Hospital Costs ◽  
The United States ◽  
Target System ◽  
Treatment Providers ◽  
Prolonged Hospital ◽  
The Impact

Each year, as many as 98,000 hospital deaths in the United States can be attributed to medical error. Considering that at least half of all medical errors go unreported, the impact they have on mortality, morbidity, prolonged hospital stay, rising hospital costs, and the doctor-patient relationship cannot be overemphasized. At the heart of the dilemma are patients and their family members, who rely on clinicians to provide optimal medical care, devoid of mistakes and error, and want an apology if an error has taken place. In this review, we discuss the moral obligation of hospitals to disclose medical error, no matter what the impact. Whereas in the past, a paternalistic approach to medicine viewed this acknowledgment as weakness, there is now a consensus to advocate for full disclosure, apology, and discussions that facilitate early disclosure of error using teams representing administration, patient care liaisons, and treatment providers. Many institutions now recognize that medical errors are commonly the result of a breakdown of checks and balances, and an increasing number are implementing protocols that target system errors to prevent similar future occurrences. We examine institutions across the United States that take a proactive approach by assembling “communication and resolution” programs to address the concerns of patients and their families through the process of disclosure. We also explore barriers to disclosure, which are attributed to lack of training, fear of litigation, and the “shame and blame culture.” We discuss the benefit, to both patient and provider, of disclosure of accountability as we move toward a culture of strengthening systems and improving patient care and patient-provider relationships. Key words: apology, culture, disclosure, error, resolution

scholarly journals Reducing Noninfectious Risks of Blood Transfusion

2011 ◽  
Vol 115 (3) ◽  
pp. 635-649 ◽  
Author(s):  
Brian M. Gilliss ◽  
Mark R. Looney ◽  
Michael A. Gropper ◽  
David S. Warner
Keyword(s):  
United States ◽  
Acute Lung Injury ◽  
Blood Transfusion ◽  
Lung Injury ◽  
Causes Of Death ◽  
The United States ◽  
Morbidity And Mortality ◽  
Circulatory Overload ◽  
Transfusion Reactions

As screening for transfusion-associated infections has improved, noninfectious complications of transfusion now cause the majority of morbidity and mortality associated with transfusion in the United States. For example, transfusion-related acute lung injury, transfusion-associated circulatory overload, and hemolytic transfusion-reactions are the first, second, and third leading causes of death from transfusion, respectively. These complications and others are reviewed, and several controversial methods for prevention of noninfectious complications of transfusion are discussed, including universal leukoreduction of erythrocyte units, use of male-only plasma, and restriction of erythrocyte storage age.

Disclosure of Error in the Intensive Care Unit

2017 ◽  
Author(s):  
Leslie Hale ◽  
Katrina Kirksey Harper ◽  
Anna Bovill Shapiro
Keyword(s):  
United States ◽  
Patient Care ◽  
Medical Errors ◽  
Medical Error ◽  
Hospital Costs ◽  
The United States ◽  
Target System ◽  
Treatment Providers ◽  
Prolonged Hospital ◽  
The Impact

Each year, as many as 98,000 hospital deaths in the United States can be attributed to medical error. Considering that at least half of all medical errors go unreported, the impact they have on mortality, morbidity, prolonged hospital stay, rising hospital costs, and the doctor-patient relationship cannot be overemphasized. At the heart of the dilemma are patients and their family members, who rely on clinicians to provide optimal medical care, devoid of mistakes and error, and want an apology if an error has taken place. In this review, we discuss the moral obligation of hospitals to disclose medical error, no matter what the impact. Whereas in the past, a paternalistic approach to medicine viewed this acknowledgment as weakness, there is now a consensus to advocate for full disclosure, apology, and discussions that facilitate early disclosure of error using teams representing administration, patient care liaisons, and treatment providers. Many institutions now recognize that medical errors are commonly the result of a breakdown of checks and balances, and an increasing number are implementing protocols that target system errors to prevent similar future occurrences. We examine institutions across the United States that take a proactive approach by assembling “communication and resolution” programs to address the concerns of patients and their families through the process of disclosure. We also explore barriers to disclosure, which are attributed to lack of training, fear of litigation, and the “shame and blame culture.” We discuss the benefit, to both patient and provider, of disclosure of accountability as we move toward a culture of strengthening systems and improving patient care and patient-provider relationships. Key words: apology, culture, disclosure, error, resolution

scholarly journals Severe Maternal Morbidity and Mortality Among Indigenous Women in the United States

2020 ◽  
Vol 135 (2) ◽  
pp. 294-300 ◽  
Author(s):  
Katy B. Kozhimannil ◽  
Julia D. Interrante ◽  
Alena N. Tofte ◽  
Lindsay K. Admon
Keyword(s):  
United States ◽  
Maternal Morbidity ◽  
The United States ◽  
Indigenous Women ◽  
Morbidity And Mortality ◽  
Severe Maternal Morbidity ◽  
Maternal Morbidity And Mortality

scholarly journals Healthcare-Associated Infections among Patients in a Large Burn Intensive Care Unit: Incidence and Pathogens, 2008–2012

2014 ◽  
Vol 35 (10) ◽  
pp. 1304-1306 ◽  
Author(s):  
David J. Weber ◽  
David van Duin ◽  
Lauren M. DiBiase ◽  
Charles Scott Hultman ◽  
Samuel W. Jones ◽  
...  
Keyword(s):  
United States ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
The United States ◽  
Burn Injuries ◽  
Morbidity And Mortality ◽  
Common Source ◽  
Healthcare Associated Infections ◽  
Burn Patients ◽  
Healthcare Associated

Burn injuries are a common source of morbidity and mortality in the United States, with an estimated 450,000 burn injuries requiring medical treatment, 40,000 requiring hospitalization, and 3,400 deaths from burns annually in the United States. Patients with severe burns are at high risk for local and systemic infections. Furthermore, burn patients are immunosuppressed, as thermal injury results in less phagocytic activity and lymphokine production by macrophages. In recent years, multidrug-resistant (MDR) pathogens have become major contributors to morbidity and mortality in burn patients.Since only limited data are available on the incidence of both device- and nondevice-associated healthcare-associated infections (HAIs) in burn patients, we undertook this retrospective cohort analysis of patients admitted to our burn intensive care unit (ICU) from 2008 to 2012.

Role of Image-Guided Percutaneous Drainage in Pancreatic Collections

2018 ◽  
Vol 02 (02) ◽  
pp. 125-130
Author(s):  
Katayoun Samadi ◽  
Ronald Arellano
Keyword(s):  
United States ◽  
Acute Pancreatitis ◽  
Percutaneous Drainage ◽  
Hospital Admissions ◽  
Disease Process ◽  
The United States ◽  
Morbidity And Mortality ◽  
Image Guided ◽  
Gastrointestinal Conditions

AbstractAcute pancreatitis is one of the major gastrointestinal conditions that lead to around 300,000 hospital admissions per year in the United States. While mild inflammation of the pancreas is often managed conservatively, progression of the disease process to necrosis significantly increases the overall morbidity and mortality and often requires surgical or other interventional techniques for management. The purpose of this review is to describe the role of percutaneous drainage for the management of complicated pancreatitis.

Dimensions of Jewish-American Identity

1973 ◽  
Vol 33 (3) ◽  
pp. 891-900 ◽  
Author(s):  
Itai Zak
Keyword(s):  
United States ◽  
Factor Analysis ◽  
Test Scores ◽  
Common Factor ◽  
The United States ◽  
American Identity ◽  
Jewish American ◽  
Cast Doubt ◽  
The Common ◽  
High Degree

The main problem posed in this study is: What are the content and structure of Jewish and American identity? The Jewish-American Identity Scale, which was adapted and refined for this study, was administered in 1971 to four samples, totaling 1006 Jewish-American college students from various parts of the United States. Initially, factor analysis was applied to the separate samples. Intersample comparisons of factor structures indicated a high degree of congruency; consequently, the samples were combined for subsequent analyses. Factor analysis of the test scores demonstrated that most of the common factor variance was appropriated by two relatively orthogonal factors. Items dealing with American identity and those dealing with Jewish identity had medium to high loadings on the two respective factors. These findings supported the hypothesis of the duality and the orthogonality of dimensions of Jewish and American identity, and cast doubt on the notion forwarded by some researchers that Jewish-American identity forms a bipolar continuum.

Sign in / Sign up

Export Citation Format

Share Document