Incidence rate and financial burden of medical errors and policy interventions to address them: a multi-method study protocol

Medical error is one of the most critical challenges facing medical services. They pose a substantial threat to patient safety, and their costs draw attention from policymakers, health care planners and researchers. We aim to make a realistic estimation of medical error incidence and related costs and identify factors influencing this incidence in Iranian hospitals. In the first phase of this multi-method study, through two reviews of systematic reviews and a meta-analysis, we will estimate the incidence of medical errors and the strategies to reduce them. We will extract available data among 41 hospitals supervised by the East Azerbaijan University in the second phase. We will also develop a model and use a Delphi method to predict medical errors incidence and calibrate our model output using the Monte Carlo simulation. We will compare this estimation with the incidence rate based on meta-analysis results from the first phase. In the third phase, we will investigate the relationship between several factors potentially influencing medical error incidence. In the fourth phase, we will estimate costs associated with medical errors by conducting a patient records review and matching those with claims related to medical errors. In the fifth phase, we will present a policy brief related to strategies for medical errors and associated costs reduction in Iran. Our findings could benefit Iranian and policymakers in other countries to reduce medical errors and associated costs.

Emotional Labor, Burnout, Medical Error, and Turnover Intention among South Korean Nursing Staff in a University Hospital Setting

Nurses are vulnerable to mental health challenges, including burnout, as they are exposed to adverse job conditions such as high workload. The mental health of this population can relate not only to individual well-being but also to patient safety outcomes. Therefore, there is a need for a mental health improvement strategy that targets this population. This cross-sectional survey study investigates emotional labor, burnout, turnover intention, and medical error levels among 117 nursing staff members in a South Korean university hospital; it also analyzes correlations among outcomes and conduct correlation analysis and multiple regression analysis to determine relationships among these factors. The participants had moderate to high levels of emotional labor and burnout, and 23% had experienced medical errors within the last six months. Save for medical errors, all outcomes significantly and positively correlated with each other. These results can be used to improve the mental health outcomes of nurses working in the hospital and their consequences. Specifically, the job positions of nursing personnel may be a major consideration in such a strategy, and job-focused emotional labor and employee-focused emotional labor may be promising targets in ameliorating turnover intention and client-related burnout, respectively.

Narrowing the mindware gap in medicine

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.

Factors That Influence Human Error and Patient Safety in the Pre-hospital Emergency Care Setting: Perspectives of Emergency Care Practitioners in a Middle-income Country

Background: Delivering pre-hospital emergency care has the potential to be hazardous, and the patient could experience an adverse event. Despite these potential, yet known, threats, little is known about patient safety in the pre-hospital care setting, in contrast to in-hospital care. In South Africa, there are no reports on patient safety and human error issues in the pre-hospital care setting. This study investigated the perspectives of emergency care practitioners (ECPs) in South Africa on the types of errors that occur in the pre-hospital emergency care setting, as well as factors that influence patient safety and precipitate errors during pre-hospital care.Methods: This research was designed as an exploratory study that used a questionnaire administered on 2000 ECPs to obtain their perceptions on factors the influence human error and patient safety in the pre-hospital emergency care environment. Results: Of the 2000 questionnaires distributed, 1,510 were returned, giving a response rate of 76%. Analysis of the respondents’ responses in relation to the types of human errors in the pre-hospital environment yielded five dominant themes, namely errors relating to poor judgement, poor skill/knowledge, fatigue, and communication, and human error. According to the participants, inadequate equipment, environmental factors, personal safety concerns, practitioner’s incompetence, and ineffective teamwork are the top five factors that influence patient safety in the pre-hospital emergency care setting. The majority (65.1%; p < 0.001) of public sector ECPs reported that they had not received training on patient safety, nor do they have a protocol for managing medical error at their workplace (65.7%; p < 0.007). Conclusion: In conclusion, this study investigated paramedics’ views on types of errors that occur in the pre-hospital emergency care setting, and factors that influence patient safety and precipitate errors during pre-hospital care. It was found that public-sector emergency medical service (EMS) in South Africa seldom train their staff on patient safety or have a protocol for managing medical error. The study advocates that, to overcome medical errors, EMS in South Africa should establish a culture of safety that focuses on system improvement and personnel training.