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A 2000 Institute of Medicine report on patient safety called for voluntary and mandatory reporting systems to identify and learn from medical errors in health care. Yet focusing on medical injury instead of medical error may be more appropriate and productive. Rather than culpability, this public health approach emphasizes preventability, which should be the ultimate goal of patient safety efforts, according to Peter M. Layde, M.D., M.Sc., of the Medical College of Wisconsin, whose work is supported in part by the Agency for Healthcare Research and Quality (HS11893).
In a recent commentary, Dr. Layde and his colleagues note that the difficulty in reliably identifying medical errors and the potential for preventing medical injuries not associated with error suggest the benefit of an injury-oriented approach. By targeting error alone, any investigation of medical errors focuses on a relatively small subset of medical injuries and misses the majority. Also, institutional and professional fear of legal discovery in medical malpractice litigation is a major barrier to using medical error reporting systems to improve care quality. Unless reporting is entirely anonymous, hospitals and doctors that fully disclose errors might be shunned by the public and experience economic consequences as severe as malpractice damages.
Passive injury prevention measures that require little or no effort on the part of the individual, such as engineered changes in the environment (for example, redesigned needles to reduce needlestick injuries), have been found to be more effective than active approaches. The latter approaches require more active involvement and effort on the part of individuals to avert injury events (for example, use of gloves when handling patients' bodily fluids to reduce transmission of HIV).
See "Patient safety efforts should focus on medical injuries," by Dr. Layde, Leslie A. Maas, M.H.S., Stephen P. Teret, J.D., M.P.H., and others, in the April 17, 2002 Journal of the American Medical Association 287(15), pp. 1993-1997.
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