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Ly, Huong Q. "Medical Laboratory Managers Success with Preanalytical Errors." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3498.
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Clinicians rely heavily on accurate laboratory results to diagnose and treat their patients. Laboratory errors can occur in any area of total testing phases, but more than half of the errors occur in the preanalytical phase. Framed by the total quality management theory, the purpose of this multiple case study was to explore medical laboratory managers' strategies to reduce preanalytical errors. A purposive sample of 2 organizations with laboratories in southern California participated in semistructured face-to-face interviews. Company A had 2 participants and 3 participants participated in the study from Company B. Each participant had at least 5 years of laboratory experience, with a minimum of 2 years of management experience in preanalytical testing, and had completed one project to minimize laboratory errors. Thematic analysis exposed 5 main themes: quality improvement, recognition, reward, and empowerment, education and training, communication, and patient satisfaction. The participants highlighted the need for organizations to concentrate on quality management to achieve patient satisfaction. To achieve quality services, medical laboratory managers noted the importance of employee engagement, education and training, and communication as successful strategies to mitigate preanalytical errors. The recommendation for action is for laboratory leaders to review and apply effective strategies exposed by the data in this study to reduce preanalytical errors in their medical laboratory. Positive implications of this study include reduction of preanalytical errors, increased operational cost, and improved patient experience.
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Al-Shirawi, Ali. "Medical errors: defining the confines of system weaknesses and human errors." Thesis, McGill University, 2011. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=97142.
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Notwithstanding the innovative changes in biotechnology, medical devices and other therapeutics, errors in medicine continue to cause harm to patients. Current definitions of medical error do not reflect the full reality of error causation. Medical error taxonomy is narrowly focused on system weaknesses in health institutions and human error. System weaknesses in licensing and monitoring organizations, health care suppliers, health profession self-regulation and government regulating organizations, conduct by leading health professionals and medical research industry risks, all lead to significant harm that is not recognized in medical error accountability. These players do not fulfill their mandates. Evidence demonstrates negligence, incompetence, unethical conduct and institutional interest and self-interest in the decision-making process. Both the principled approach and institutional ethics (IE) principles are powerful tools to require accountability from stakeholders. The contemporary understanding of medical errors is deficient and unsustainable. It has not contributed to a decrease in errors. Appropriate definitions of the confines of systems weaknesses and human error are required. This thesis outlines a method to perceive medical errors in a broader way, combining the many agents of error/harm into one system, thereby highlighting accountability and paving the way for reform.Malgré les changements innovateurs dans la biotechnologie, l'équipement médical et d'autres approches thérapeutiques, les erreurs dans la pratique de la médecine continuent à provoquer des problèmes médicaux pour un nombre important de patients. Les définitions actuelles d'erreurs médicales ne reflètent pas la réalité complète de la causalité d'erreurs. La taxinomie d'erreurs médicale est aussi strictement concentrée sur les faiblesses du système dans les institutions de santé et l'erreur humaine. Les faiblesses des systèmes qui autorisent et contrôlent les organisations, les fournisseurs de santé publique, les règlements des professions de la santé, les organismes de règlements gouvernemental des professions de la santé et la conduite des professionnels de la santé, et les risques de l'industrie de recherche médicale, tous causent des problèmes importants qui ne sont pas actuellement explicitement reconnu pour leur responsabilité d'erreurs médicales. Ces joueurs ne réalisent pas leurs autorité actuelle. L'évidence démontre de la négligence, de l'incompétence, d'une conduite non étique, d'un intérêt institutionnel et d'un intérêt personnel dans le processus de prise de décision par ces instances. C'est-à-dire, l'approche du principe que les principes de l'éthique institutionnelle sont des instruments puissants pour contraindre la responsabilité de tous les joueurs. La vision contemporaine des erreurs médicales est déficiente et non durable. Une telle vision est déficiente et non supportable. Elle n'a pas contribué à la réduction d'erreurs médicales. Une formulation sur les définitions nécessaires des limitations des systèmes liés à l'être humain est nécessaire. La proposition de cette thèse expose une façon de percevoir les erreurs médicales dans le but de rejoindre les nombreux agents d'erreur et de mal dans un système en mettant ainsi l'emphase sur la responsabilité, et ainsi ouvrant la voie à la réforme.
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Varnam, Robert. "Patient perspectives on medical errors in general practice." Thesis, University of Manchester, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.514434.
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Patient safety is as an increasingly active field of research and policy in the UK and around the world. The prevailing academic model for understanding the cause of patient safety incidents considers failures in cognitive and system aspects of care to playa role, with an emphasis on system factors in preventing harm. General practitioners (GPs) are the first port of call for a wide range of undifferentiated medical, psychological and social problems, presented by patients with whom they may form lasting relationships. The priorities and processes of care in general practice are consequently less clearly defined, more individualised and more strongly influenced by the people involved than in the hospital settings where the existing model was developed. Research in general practice has thus far been conducted from a professional standpoint, using doctors' reports to detect and understand safety incidents. Patients may bring a valuable new perspective to understanding the nature, incidence and cause of adverse events in general practice, allowing the existing model to be refined. This study aimed to provide a detailed description and analysis of patients' perspective on episodes of care they regarded as regrettable. A qualitative approach was used, conducting in-depth interviews with 34 patients whose healthcare experiences made them likely to be good key informants regarding patient safety issues in general practice. An adaptive theorising approach was used, to allow grounded insights arising from the empirical data to be interpreted in the light of, and to add to the development of, theories about the causation of adverse events. The results showed respondents' evaluations of GPs' medical performance to be contingent on their expectations, prior experiences and the doctor-patient relationship. They understood the quality and safety of GPs' care to be determined by their knowledge, skills and an attitude of professional commitment, using this understanding to inform the attribution of responsibility or blame for their experiences of care. This approach differed from the prevailing academic model in that it focussed on errors more than adverse outcomes, placed a strong emphasis on the importance of personal and relational factors in error causation and paid relatively little attention to the role of system factors. It identified diagnostic error as a significant issue in general practice, highlighting the dependence of technical aspects of care upon the GP's personal and interpersonal performance. Having sufficient professional commitment to choose to perform well was seen as a prerequisite for the safe application of knowledge and skills. Even where little or no physical harm was sustained, errors attributed to a failing in professional commitment could result in Significant psychological distress, loss of trust, and changes in future help-seeking behaviour. Interpersonal aspects of care and personal factors in GP performance appear to be key influences on safety in this context. This has implications for the focus of safety improvement efforts, which may need to take more account of the role of the individual professional, alongside issues of human factors and system design. A renewed emphasis is recommended on traditional values of altruistic professionalism and personal responsibility. Patients may make good partners in improving safety, provided it is acknowledged that their perspective is subject to socially patterned biases, and that they are sometimes hesitant to challenge medical authority.
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Dugay, Murielle Boetcher Sandra Kathleen Sparr. "Errors in skin temperature measurements." [Denton, Tex.] : University of North Texas, 2008. http://digital.library.unt.edu/permalink/meta-dc-9786.
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Troëng, Thomas. "On errors & adverse outcomes in surgery learning from experience /." Malmö : Dept. of Community Health Sciences and the Dept. of Surgery, Malmö General Hospital, University of Lund, 1992. http://catalog.hathitrust.org/api/volumes/oclc/38946479.html.
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Robinson, Mary Jane. "Diagnostic Medical Errors and Their Impact on Patient Safety." Thesis, Northcentral University, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10787186.
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The purpose for this qualitative research was to provide comparative data to determine if there was areas in need of improvement when it pertained to medical errors. Researchers have validated that initiating measures for continuous improvement would minimize error rates and benefit the clinicians and their patients. Patient safety was important and cause major concerns, therefore this research explored categories that influenced decision-making processes or conditions that causes deficit in reasoning, which could have an impact on cognitive abilities. Therefore, medical errors are a research worthy problem; since they cause phenomenon, conflict within managerial processes, and was a contributing factor for malpractice payouts, per a report from 2015 Institute of Medicine. As a result, researchers validated that initiating measures for continuous improvement would benefit the clinicians and their patients by minimizing errors or keeping them at a minimum. Utilizing the qualitative approach provided the best framework to narrow down cause and effects to validate the importance of support that relates to memory and relational network through retrieval-mediated learning. This research provides evidence that medical errors occurred during decision-making processes with (90%) cognitive errors, anchoring (75.7%), and (78.6%) premature closure. As a result, this qualitative research concentrated on constructs, such as, data collection from observation of prior research from scholarly, empirical, peered reviewed articles; Medical Journals, and education materials to provide pertinent information on diagnostic medical errors for the material within this investigation. The results from this study indicated, although, there was suggestions to improve patient-safety no significant decrease in medical harm occurred, therefore additional investigations will provide a valuable contribution to the body of knowledge and conditions for continuous improvement.
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Savage, Lynette M. "Intuitive decisions as a means of preventing medical errors." ScholarWorks, 2009. https://scholarworks.waldenu.edu/dissertations/636.
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Medical errors occur despite precautionary measures. Limited research has focused on intuition in preventing medical errors. The problem addressed in this study explored the role of intuition by health care team members in preventing medical errors from reaching hospitalized patients. The research questions focused on the differences in response to medical errors by health care team members from 3 West Coast hospitals. The theoretical framework included human error, personality typing, skill acquisition, and a model of intuition. In this exploratory mixed method study 1,836 unusual occurrence reports submitted over 6 months were analyzed. Of the 710 health care team members surveyed, 201 (28%) completed an intuitive score instrument. Eight health care team members were interviewed, with responses analyzed for themes of knowledge management implicit to intuition. The unusual occurrences results were categorized as near miss or adverse event and analyzed using t tests. There were no differences in a comparison of mean intuition scores for type of error and levels of intuition by participant age or gender. Differences were found in the number of documented constructs of intuition by type of error and discipline in the comparison of pharmacy to nursing and diagnostic imaging. Interview excerpts were compiled for use by managers to role model through storytelling how intuition can prevent medical errors. Research is needed to understand how to incorporate skills of tacit recognition and intuition. Preventing costly and potentially life-threatening medical errors is fundamental to addressing the societal need to lower costs and provide safer patient care.
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Waring, Justin J. "The social construction and control of medical errors : a new frontier for medical/managerial relations?" Thesis, University of Nottingham, 2004. http://eprints.nottingham.ac.uk/11819/.
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This thesis explores changes in medical professional work and regulation in the context of emerging 'patient safety' health policies. The study engages with three components of this policy. First, to what extent is the concept of error promoted in theory and policy being taken up within managerial practice and is this coterminous with the medical interpretation and construction of error? Second, how do medical professionals regard the introduction of new reporting systems to collect information about errors in their work? Third, what new organisational systems are being developed to analyse and control errors and how do these diverge with those approaches advocated and practiced by medical professionals? It has been estimated that one in ten of all inpatient admissions experience some form of error in the delivery of care, totalling 850,000 events a year. Given such findings a new policy framework is being developed to improve 'patient safety' in the NHS. Following the Human Factors approach a new error management system is being introduced that consists of incident reporting procedures for the collection of information about errors, matched by techniques to identify the "root causes", and promote organisational change. Of importance for this thesis is the impact of policy on established forms of medical regulation. Through predominantly qualitative research techniques, this study has been carried out within a single NHS hospital case-study involving medical and managerial occupational groups. The empirical findings suggest, firstly, that the medical construction of error is indeed divergent from that advocated in policy and practiced in management and leads to distinct trajectories for the control of error. Secondly, medical professionals are generally disinclined to participate in managerial forms of incident reporting, and where such a system is in place there is a high degree of localised professional leadership. Thirdly, it was found that alongside new managerial systems for the control of errors, there were also a range of professional-led systems embedded within medical work and the local organisation of the hospital that had precedence of other centralised hospital systems. In consequence, the ability of managerial systems to penetrate the working environment of medicine was negligible. In conclusion, it is argued that while this policy could appear to challenge the basis of medical professional regulation the social, cultural and structural context of medical work is adapting to maintain a high degree of medical control and resist managerial encroachment.
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Johansson, Lars Age. "Targeting Non-obvious Errors in Death Certificates." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Universitetsbiblioteket [distributör], 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-8420.
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Greig, Paul. "Perceptual error in medical practice." Thesis, University of Oxford, 2016. https://ora.ox.ac.uk/objects/uuid:bea354bf-7c2f-44da-a24f-83a2df804b69.
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Introduction: Medical errors are major hazards, and lapses in non-technical skills such as situational awareness contribute to most incidents. Risks are concentrated in acute care, and in crisis situations clinicians can apparently ignore vital information. Poor workplace ergonomics contributes to risk. Existing work into perceptual errors offers insights, but these phenomena have been little researched in medicine. This thesis considers medical non-technical skills and how they are taught, and explores vulnerability to inattentional and change blindness. Methods: Medical human factors and the psychology of perceptual error were reviewed, and a mixed-methods assessment of postgraduate medical curricula completed. Experiments assessed clinicians' interaction with clinical monitoring devices using eye-tracking, and studies were conducted exposing clinicians to various perceptual error stimuli using non-clinical and clinical videos, and simulation. A survey was also conducted to assess clinicians' insight into the phenomena of perceptual error. Results: Non-technical skills feature poorly in medical curricula, and equipment is poorly standardised in critical care areas. Unfamiliar devices slow response times and increase error rate. Clinical training confers no generalisable advantage in perceptual reliability. Even expert clinicians miss important events. Two out of every three life-support instructors for example missed a critical failure in the patient's oxygen supply when watching a recorded emergency simulation. The insight and understanding healthcare staff have of perceptual errors is poor, leading to significant overestimates of perceptual reliability that could have consequences for clinical practice. Conclusions: Perceptual errors represent a latent risk factor contributing to loss of situational awareness. High rates of perceptual error were observed in the video-based experiment. Although lower rates were observed in simulation, important events were still missed by participants that could have serious consequences. The incidence of perceptual error appears sensitive to the method used to test for it, and this has important implications for the design of future experiments testing for these phenomena. Mitigating perceptual error is likely to be challenging, but relatively simple adjustments to team practices in emergency situations may be fruitful.
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Folligah, Jean-Pierre K. "Determining Perceived Barriers Affecting Physicians' Readiness to Disclose Major Medical Errors." Thesis, Walden University, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10811358.
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Medical errors have been detrimental in the field of medicine. They have impacted both patients and doctors. While physicians recognized that error disclosure was an ethical and professional obligation, most remained silent when mistakes happened for different reasons. Guided by the theory of planned behavior and Kant's deontological theory, the purpose of this quantitative study was to investigate the perceived barriers affecting physicians' willingness to report major medical errors. An association was tested between the independent variables physician fear of disclosure of errors, organizational culture toward patient safety, physician apology, professional ethics and transparency, physician education, and the dependent variable physician willingness to disclose major medical errors. Using a cross-sectional method, 122 doctors out of 483 surveyed, completed the online and paper-based survey. Multiple linear regression and descriptive statistics models were used to analyze and summarize the data. The results showed there was a statistically significant relationship between the independent variables organizational culture toward patient safety, physician apology, professional ethics and transparency, and physician education and the dependent variable physician willingness to disclose major medical errors. There was no relationship between the independent variable fear of disclosure of errors and the dependent variable. The findings added to the knowledge base regarding barriers to physicians' medical errors disclosure. The results and recommendations could provide positive social change by helping hospitals raising doctors' awareness regarding major medical errors disclosure.
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Taylor-Hyde, Dr Mary Ellen. "Human Resource Strategies for Improving Organizational Performance to Reduce Medical Errors." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3580.
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Preventable medical errors are the third leading cause of death in the United States. Healthcare leaders must consistently promote the delivery of quality and safe care of patients to reduce unnecessary errors and prevent harm. The purpose of this case study was to explore human resource strategies for improving organizational performance to reduce medical errors. The study included face-to-face interviews with 5 healthcare clinical managers who work within a multifaceted health system in the Midwestern region of the United States. Complex adaptive systems theory was used to frame this study. Interview notes, publicly available documents, and audio recordings were transcribed and analyzed to identify themes regarding strategies used by managers to find effective ways for improvement. Four themes emerged: addressing seminal/never events, ongoing training programs, communication/collaboration, and promoting a culture of safety and quality. Results may directly benefit healthcare managers by facilitating successful strategies to reduce preventable medical errors through education, feedback, innovation, and leadership. Implications for social change for healthcare managers include continued training, building a culture of safety, and using collaborative and communicative efforts while making contributions to the best practices within healthcare organizations to reduce the likelihood of medical errors.
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Mårtensson, Mattias. "Evaluation of Errors and Limitations in Ultrasound Imaging Systems." Doctoral thesis, KTH, Medicinsk teknik, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-34177.
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There are binding regulations requiring safety and efficacy aspects of medical devices. The requirements ask for documentation that the devices are safe and effective for their intended use, i.e. if a device has a measuring function it must be correct. In addition to this there are demands for quality systems describing development, manufacturing, labelling, and manufacturing of a device. The requirements are established to guarantee that non-defective medical devices are used in the routine clinical practice. The fast rates in which the imaging modalities have evolved during the last decades have resulted in numerous new diagnostic tools, such as velocity and deformation imaging in ultrasound imaging. However, it seems as if the development of evaluation methods and test routines has not been able to keep up the same pace. Two of the studies in this thesis, Study I and IV, showed that computed tomography-based and ultrasound based volume measurements can yield very disparate measurements, and that tissue Doppler imaging-based ultrasound measurements can be unreliable. Furthermore, the new ultrasound modalities impose higher demands on the ultrasound transducers. Transducers are known to be fragile, but defective transducers were less of a problem earlier when the ultrasound systems to a lesser extent were used for measurements. The two other studies, Study II and III, showed that serious transducer errors are very common, and that annual testing of the transducers is not sufficient to guarantee an error free function. The studies in the thesis indicate that the system with Notified Bodies, in accordance with the EU’s Medical Device Directive, checking the function and manufacturing of medical devices does not work entirely satisfactory. They also show that the evaluation of new methods have led to the undesirable situation, where new measuring tools, such as volume rendering from imaging systems, and tissue Doppler-based velocity and deformation imaging in echocardiography are available for clinicians without proven knowledge about their accuracy.QC 20110527
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Dugay, Murielle. "Errors in skin temperature measurements." Thesis, University of North Texas, 2008. https://digital.library.unt.edu/ark:/67531/metadc9786/.
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Numerical simulation is used to investigate the accuracy of a direct-contact device for measuring skin-surface temperature. A variation of thermal conductivity of the foam has greater effect on the error rather than a variation of the blood perfusion rate. For a thermal conductivity of zero, an error of 1.5 oC in temperature was identified. For foam pad conductivities of 0.03 and 0.06 W/m-oC, the errors are 0.5 and 0.15 oC. For the transient study, with k=0 W/m-oC, it takes 4,900 seconds for the temperature to reach steady state compared with k=0.03 W/m-oC and k=0.06 W/m-oC where it takes 3,000 seconds. The configuration without the foam and in presence of an air gap between the skin surface and the sensor gives the most uniform temperature profile.
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Boone, Amanda Carrie. "Methodology for evaluating and reducing medication administration errors." Master's thesis, Mississippi State : Mississippi State University, 2003. http://library.msstate.edu/etd/show.asp?etd=etd-07202003-190139.
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Zambon, Lucas Santos. "Segurança do paciente em terapia intensiva: caracterização de eventos adversos em pacientes críticos, avaliação de sua relação com mortalidade e identificação de fatores de risco para sua ocorrência." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/5/5165/tde-04082014-085402/.
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Introdução: A segurança do paciente é tema de grande importância pois muitos pacientes hospitalizados são vítimas de eventos adversos (EAs). Evento adverso é um incidente que resulta em dano desnecessário ao paciente, de caráter não intencional, e que está associado à assistência prestada, e não com a evolução natural da doença do indivíduo. As unidades de terapia intensiva (UTIs) são ambientes propícios à ocorrência de EAs, porém não há dados abrangentes sobre EAs em UTIs no Brasil. Além disso é preciso verificar se a ocorrência de EAs é fator de risco para morte em UTI, e quais são os fatores de risco para sua ocorrência. Objetivos: Identificar e caracterizar EAs em UTIs do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), avaliar se há relação entre ocorrência de EAs e morte em UTIs, e identificar quais os fatores de risco para a ocorrência de EAs nesses locais. Métodos: Estudo observacional do tipo coorte que analisou admissões consecutivas em UTIs no HC-FMUSP entre Junho e Agosto de 2009. Os casos foram acompanhados até a saída da UTI, seja alta ou óbito. Foram coletados dados sobre aspectos clínicos, escores de gravidade (APACHE II, SAPS II, SOFA), carga de trabalho de enfermagem (NAS) e intervenções realizadas. EAs foram identificados através da revisão de prontuários e observação dos profissionais médicos e de enfermagem, sendo classificados quanto ao tipo e grau de dano conforme classificação da Organização Mundial da Saúde. Foi feita análise multivariada com regressão logística para analisar se EAs são fatores de risco independentes para morte em UTI. Foi feita uma segunda análise multivariada com regressão logística para verificar quais são os fatores de risco para ocorrência de EAs com alto grau de dano (AGD). Resultados: Ocorreram 1126 EAs em 81,7% das 202 admissões estudadas. Os EAs mais frequentes foram os das categorias processo clínico/procedimento (54% dos EAs), medicação (25,8%), nutrição (13,9%), e infecção (5,5%). Quanto ao dano, 74,4% foram EAs leves, 19,4% moderados, 4,1% graves e 2,1% associados a óbito. A ocorrência de 4 a 6 EAs na internação mostrou-se um fator de risco para óbito em UTI (OR:18,517; IC95%:1,043-328,808; P=0,047), assim como a ocorrência de >= 7 EAs (OR:32,084; IC95%:1,849-556,684; P=0,017). Quanto aos tipos, a ocorrência de EA do tipo processo clínico/procedimento mostrou-se fator de risco para óbito em UTI (OR:9,311; IC95%:1,283-67,556; P=0,027), bem como a ocorrência de EA com AGD (OR:38,964; IC95%:5,620-270,151; P < 0,001). Foram identificados os seguintes fatores de risco para ocorrência de EAs com AGD: NAS médio de 70,1% a 82,3% (OR:6,301; IC95%:1,164- 34,117; P=0,033), NAS médio >= 82,4% (OR:9,068; IC95%:1,729-47,541; P=0,009), SOFA médio entre 4,5 a 6,7 (OR:6,934; IC95%:1,239-38,819; P=0,028), e um SOFA médio >= 6,8 (OR:10,293; IC95%:1,752-60,474; P=0,010). Conclusões: EAs acometeram muitas admissões das UTIs estudadas, sendo que mais da metade destes eventos foi do tipo processo clínico/procedimento. Cerca de 6% dos EAs foi considerado grave ou associado ao óbito do paciente. A ocorrência de EAs foi um fator de risco independente para óbito, principalmente EAs do tipo processo clínico/procedimento e EAs com AGD. Os fatores de risco para ocorrência de EAs com AGD foram a carga de trabalho de enfermagem e a gravidade do pacienteIntroduction: Patient safety is a matter of great importance because many hospitalized patients are victims of adverse events (AEs). Adverse event is an unintentional incident that results in unnecessary patient harm, that is associated with the care provided, and not with the natural evolution of the individual\'s disease. The intensive care units (ICUs) are prone environments to the occurrence of AEs, but there is no comprehensive data on AEs in ICUs in Brazil. Is not known for sure if AEs are risk factors for death in ICUs, and what are the most important risk factors for AEs occurrence in ICUs. Objectives: To identify and characterize AEs in ICUs of the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), to evaluate relationship of AEs with death in ICUs, and to identify risk factors for the occurrence of AEs. Methods: This is an observational cohort study of consecutive admissions to ICUs of HC-FMUSP analyzed between June and August 2009. The cases were followed until discharge from the ICU, dead or alive. Data on clinical features, severity scores (APACHE II, SAPS II, SOFA), nursing workload (NAS) and interventions were collected. AEs were identified by reviewing medical records and observation of medical and nursing professionals, and they were classified according to type and degree of harm as classified by the World Health Organization. Multivariate analyzes were performed with logistic regression to examine whether EAs are independent risk factors for death in the ICU. A second multivariate logistic regression analysis was performed to verify what are the risk factors for the occurrence of AEs with high damage (HD). Results: There were 1126 AEs in 81.7% of 202 admissions studied. 1126 AEs occurred in 81.7% of 202 admissions studied. The most common AEs were the categories of clinical process / procedure (54% of AEs), medication (25.8%), nutrition (13.9%), and healthcare-associated infection (5.5%). The occurrence of 4-6 AEs at admission was a risk factor for death in the ICU (OR:18.517; 95%CI:1,043-328,808; P=0.047 ), as well as the occurrence of >= 7 AEs (OR:32.084; 95%CI:1,849-556,684; P=0.017). Regarding the types, the occurrence of AE of clinical process / procedure type was as risk factor for death in the ICU (OR:9.311; 95%CI:1,283-67,556; P=0.027) as well as the occurrence of AE with HD (OR:38.964; 95%CI:5,620-270,151; P < 0.001) . The following risk factors were identified for the occurrence of AEs with HD: mean NAS of 70.1% to 82.3% (OR:6.301; 95%CI:1,164-34,117; P=0.033), mean NAS >= 82.4% (OR:9.068; 95%CI:1,729-47,541; P=0.009), mean SOFA between 4.5 and 6.7 (OR:6.934; 95%CI:1,239 - 38,819; P=0.028), and mean SOFA >= 6,8 (OR:10.293; 95%CI:1,752-60,474; P=0.010). Conclusions: AEs occurred in many studied ICU admissions, and more than half of these events was clinical process / procedure type. About 6% of AEs were considered serious or associated with death of the patient. The occurrence of AEs was a independent risk factor for death, especially the clinical process / procedure type, and AEs with HD. Risk factors for the occurrence of AEs with HD were the nursing workload and the patient severity
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Jenkins, James J. "Laboratory data and patient safety." Columbus, Ohio : Ohio State University, 2005. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=osu1135271306.
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Dempsey, Jared. "Speaking up for safety : examining factors which influence nurses' motivation to mitigate patient risk by challenging colleagues in situations of potential medical error." Thesis, University of Aberdeen, 2011. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=166094.
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Research suggests that individuals in the workplace might have a difficulty sharing their perceptions of risk and challenging unsafe behaviours. This thesis utilises The Theory of Planned Behaviour to examine which factors promote or hinder healthcare workers’ willingness to speak up and confront clinicians’ risky behaviours that could lead to medical error and hence endanger patient safety. The Theory of Planned Behaviour addresses issues surrounding intentions garnered from explicitly measured variables; in addition the thesis further sought to identify attitudes to speaking up using an implicit measure approach, and an approach using a computerbased, scenario-placement, reaction time methodology. Overall, the results of the thesis’s four studies suggest that nurses’ decisions to speak up are influenced by a variety of negative and positive beliefs. These beliefs include the effect speaking up has on the nurse speaking up and the patient; the support and actions of other nurses and medical personnel; and nurses feelings of confidence, knowledge and experience. Nurses also demonstrated a belief that they are more likely to speak up than their peers. Results also suggested that nurses speak up to individuals that they trust and distrust, indicating that trust and distrust are not polar opposites. The findings suggest that if speaking up is to be promoted practitioners need to address nurses’ negative beliefs—this is especially true with regard to fears about speaking up to authority figures. Nurses stated beliefs that they are more likely to speak up than their peers might be a result of presentation-bias or self-bias, if the cause is self-bias then training nurses to be more assertive and challenge risk might be made more difficult by nurses’ collective denial that they have any difficulties speaking up.
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Snydeman, Colleen Kirwan. "Evaluation of the effect of the Peer Review Impacts Safety and Medical-errors (PRISM) Program on critical care nurses' attitudes of safety culture and awareness of recovery of medical errors:." Thesis, Boston College, 2017. http://hdl.handle.net/2345/bc-ir:107293.
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Thesis advisor: Callista RoyProblem: Nurses act as safety nets, protecting patients from harm through the identification, interruption and recovery of medical errors and adverse events but we need to know more about ways to learn from safety events. This study aimed to address a gap in our understanding of how the PRISM Program affects nurses’ attitudes of safety culture, awareness of the recovery of medical errors, and practice as they relate to patient safety and error prevention. Participants: Critical care nurses in a large academic hospital from intervention (n=95) and control (n=90) units were surveyed pre and post-implementation of the PRISM Program. Intervention unit nurse response rates were 46% pre-survey and 41% post-survey. Control unit nurses' response rates were 38% for pre-survey and 31% for post-survey responses. A total of 42 (44%) intervention unit nurses participated in the PRISM Program. Methods: A pre/post-test design with an intervention and control unit was used to evaluate the effects of the PRISM Program on nurses’ responses on the Safety Attitude Questionnaire (SAQ) and the Recovery of Medical Error Inventory (RMEI) over a three month period. Nurses responded to questions about the impact on their practice. Findings: Analysis demonstrated a significant decrease in the SAQ working conditions post-survey subscale scores and significant findings in the main effects, decreased SAQ subscales: teamwork, job satisfaction, safety climate and perceptions of hospital management. The RMEI did not produce any significant findings. Comments provided insight into some nurses’ participation in the program and the impact on their practice. Implications: A significant decrease in post-survey scores indicate that informed nurses had a more critical view of safety culture and the environment they work in. Nurses expressed a desire to further use surveillance and additional manual checks that placed increased accountability and responsibility for their role in using strategies to keep patient safe and prevent errors and patient harm
Thesis (PhD) — Boston College, 2017
Submitted to: Boston College. Connell School of Nursing
Discipline: Nursing
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Ding, Chunyan. "Medical negligence law in transitional China a patient in need of a cure /." Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B43913696.
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Walton, Merrilyn. "A multifactorial study of medical mistakes involving interns and residents." Thesis, School of Public Health, 2004. http://hdl.handle.net/2123/9309.
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Echeverri, Ana Lucia Hincapie. "Relationship between Perceived Healthcare Quality and Patient Safety." Diss., The University of Arizona, 2013. http://hdl.handle.net/10150/283602.
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The objectives of this study were to examine the association between patient perceived healthcare quality and self-reported medical, medication, and laboratory errors using cross-sectional and cross-national questionnaire data from eleven countries. In this research, quality of care was measured by a multi-faceted construct, which adopted the patient's perspectives. Five separated quality of care scales were assessed: Access to Care, Continuity of care, Communication of Care, Care Coordination, and Provider's Respect for Patients' Preferences. The findings from this investigation support a number of other published studies suggesting that Coordination of Care is an important predictor of perceived patient safety. After adjusting for potentially important confounding variables, an increase in peoples' perceptions of Coordination of Care decreased the likelihood of self-reporting medical errors (OR =0.605, 95% CI: 0.569 to 0.653), medication errors (OR =0.754, 95% CI: 0.691 to 0.830), and laboratory errors (OR =0.615, 95% CI: 0.555 to 0.681). Finally, results showed that the healthcare system type governing care processes modifies the effect of Coordination of Care on self-reported medication errors.
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Amadi, Obumneke A. "Association Between Physician Characteristics and Surgical Errors in U.S. Hospitals." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/3272.
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The high incidence of medical and surgical errors in U.S. hospitals and clinics affects patients' safety. Not enough is known about the relationship between physician characteristics and medical error rates. The purpose of this quantitative correlational study was to examine the relationship between selected physician characteristics and surgical errors in U.S. hospitals. The ecological model was used to understand personal and systemic factors that might be related to the incidence of surgical errors. Archived data from the National Practitioner Data Bank database of physician surgical errors were analyzed using bivariate and multivariate logistic regression analyses. Independent variables included physicians' home state, state of license, field of license, age group, and graduation year group. The dependent variable was surgical medical errors. Physicians' field of license and state of license were significantly associated with surgical error. Findings contribute to the knowledge base regarding the relationship between physician characteristics and surgical medical errors, and findings may be used to improve patient safety and medical care.
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Gunther, Anne M. "Nurse Mindfulness and Preventing Patient Harm." Walsh University / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=walsh1397739103.
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Queiruga, Caryn, and Rebecca Roush. "Medication Error Identification Rates of Pharmacy, Medical, and Nursing Students: A Simulation." The University of Arizona, 2009. http://hdl.handle.net/10150/623966.
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Class of 2009 AbstractOBJECTIVES: To assess the ability of pharmacy, medicine, and nursing students to identify prescribing errors METHODS: Pharmacy, medicine, and nursing students from the University of Arizona were asked to participate in this prospective, descriptive study. Pharmacy and medical students in the last didactic year of their program and traditional bachelor of nursing students in the fourth semester of their program were eligible to participate. Subjects were asked to assess a questionnaire containing three sample prescriptions, evaluate if each was correct and indicate the type of error found, if any. The primary outcome measure was the number of correctly identified prescribing errors. The secondary outcome measure was the number of correct types of error found. Error identification rates for each group were calculated. Comparisons in these rates were made between pharmacy, medicine and nursing students. Chi square tests were used to analyze the nominal data gathered from various groups. RESULTS: Pharmacy students were significantly better able to identify errors than medical and nursing students (p<0.001). Pharmacy students were significantly better able to determine the type of error (p<0.001). CONCLUSIONS: Overall, pharmacy students had higher prescribing error identification rates than medical and nursing students. More studies need to be done to determine the most appropriate way to increase prescribing error identification rates.
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Mazur, Lukasz Maciej. "The study of errors, expectations and skills for medication delivery systems improvement." Thesis, Montana State University, 2008. http://etd.lib.montana.edu/etd/2008/mazur/MazurL0508.pdf.
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Medication errors occurring in hospitals are a growing national concern. The enormous gaps in knowledge related to medication errors are often seen as major reasons for increased patient safety risks and increased waste in the hospital setting. However, little research effort in industrial and management engineering has been devoted specifically to medication delivery systems to improve or optimize their operations in terms of patient safety and systems efficiency and productivity. As a result, the current literature does not offer integrated solutions to overcome the workflow and management difficulties with medication delivery. Therefore, a better understanding of workflow and management sources of medication errors is needed to help support decisions about investing in strategies to reduce medication errors. Using qualitative and quantitative research methods the work reported in this dissertation makes several contributions to the existing body of knowledge. First, using healthcare professionals' perceptions of medication delivery system, a set of simple and logical workflow design rules are proposed. If properly implemented, the proposed rules are capable of eliminating the unnecessary variations in the process of medication delivery which cause medication errors and waste. Second, a theoretical model of 'expectations' for effective management of medication error reporting, analysis and improvement is provided. The practical implication of this theoretical model extends to effective management strategies that can increase feelings of competence and help create a culture that values improvement efforts. Third, eight propositions for effective use of a systems engineering method (in this research the "Map-to-Improve" (M2I) method) for medication delivery improvement are offered. Finally, a set of skills needed for future healthcare professionals to effectively use systems engineering methods is provided. The proposed insights into these areas can result in improved pedagogy for professional development of healthcare professionals. The practical implication extends to the development of better methods for healthcare systems analysis. In summary, the author of this research work hopes that the findings and discussions will help healthcare organizations to achieve satisfactory improvement in medication delivery.
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Naude, Jonathan Michael. "Checklist of cognitive contributions to diagnostic errors: a tool for clinician-educators." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29706.
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Background: Experienced clinician educators readily identify trainees with diagnostic reasoning difficulties but often lack training to diagnose and remediate errors. Taxonomies of cognitive causes of diagnostic errors can inform remediation, but clinician educators need simple tools to identify, record, report and provide feedback on these errors. A checklist may help achieve these goals. Objectives: To characterise the cognitive contributions to diagnostic errors (CCDEs), trainees make in patient encounters, with the view to develop training and remediation programmes for medical residents preparing for specialist examinations. Secondly, to determine examiners’ perceptions of a checklist in order to document and provide feedback on CCDEs to unsuccessful candidates and trainees making diagnostic errors in examinations, on ward rounds and during bedside teaching activities. Methods: Thirty examiners used a 17-item checklist to identify and record CCDEs made by medical residents failing patient encounters in a national specialist examination. A survey was used to explore examiners perceptions of the checklist to document and provide feedback on these errors. Results: Ninety-eight of 264 patient encounters were failed (37%). Ninety-four completed checklists documented 691 CCDEs (median of 7 per encounter). Cardiac (28.7%) and neurology patients (18.1%) constituted approximately half of the failed encounters. By category: data synthesis was more problematic than data gathering, faulty knowledge or data interpretation (35.2% vs. 25.8% vs. 21.9% vs. 17.1%); χ2=48.2, (p<0.0001 for all comparisons). The 'top five’ individual CCDEs were failure to elicit history and/or examination findings; poor knowledge of clinical features (illness scripts); case synthesis (putting the case together) and misinterpretation of clinical findings. History and physical examination-related errors accounted for 60% of the 'top 5’ CCDEs, Examination-related errors were more common than history-related errors (p<0.0001). The survey of the checklist was completed by all (30) examiners. Seventy-three percent finished the checklist in less than five minutes, describing it as comprehensive and easy to use. The majority (96.7%) thought the checklist could be a better way of providing structured feedback to unsuccessful candidates. Most examiners (93.3%) considered it a useful way of guiding bedside teaching for residents preparing for specialist examinations, and 76.7% thought it could improve feedback on CCDEs to unsuccessful candidates and guide remediation and training. Conclusion: A 17-item checklist identified three priority CCDEs which require focussed remediation and training in South African medical residency programmes: improving clinical skills, developing adequate illness scripts and 'putting a case together’. This does not require extensive pedagogic expertise but rather use of a simple tool to provide customised feedback, remediation and faculty support. We showed that the simple checklist used in this study helped clinician-educators/examiners without pedagogic expertise to diagnose and record CCDEs contributing to poor performance in high stakes examinations. Examiners endorsed the use of the checklist and its potential to improve feedback and training addressing CCDEs made by trainees at the bedside.
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Sinclair, Ann Elizabeth. "The effects of test result and diagnosticity on physicians' revisions of probability of disease in medical diagnosis." PDXScholar, 1987. https://pdxscholar.library.pdx.edu/open_access_etds/3725.
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This study examined the effects of sensitivity, specificity and result of diagnostic tests on the uses which physicians make of those results. These were compared with the Bayesian model of probability adjustment, which is generally accepted for medical diagnosis. Ninety six active members of the Oregon Academy of Family Physicians were interviewed by telephone, using a case scenario describing a patient with a newly discovered breast lump. Subjects estimated prior probability of malignancy, based on history and physical findings, and then estimated posterior probability following results of a mammogram. Mammograms varied by result (positive or negative) and by high and low values for sensitivity and specificity. Subjects were asked to indicate their confidence in each probability estimate. About one third of the subjects were also asked for their treatment threshold -- that point at which they would change from a policy of watchful waiting to one of taking some action, which was usually biopsy of the lesion.
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Montague, Diane M. "Medication errors in hospitals : to ERR is human, to report is divine." Honors in the Major Thesis, University of Central Florida, 2001. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/235.
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This item is only available in print in the UCF Libraries. If this is your Honors Thesis, you can help us make it available online for use by researchers around the world by following the instructions on the distribution consent form at http://library.ucf.edu/Systems/DigitalInitiatives/DigitalCollections/InternetDistributionConsentAgreementForm.pdf You may also contact the project coordinator, Kerri Bottorff, at kerri.bottorff@ucf.edu for more information.Bachelors
Health and Public Affairs
Legal Studies
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Duman, Benjamin. "The root causes of errant ordered radiology exams." [Boise, Idaho] : Boise State University, 2009. http://scholarworks.boisestate.edu/td/79/.
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Win, Khin Than. "The application of the FMEA risk assessment technique to electronic health record systems." Access electronically, 2005. http://www.library.uow.edu.au/adt-NWU/public/adt-NWU20050822.093730/index.html.
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Vilà, de Muga Mònica. "Factores asociados a errores de medicación en un Servicio de Urgencias Pediátrico y estrategias de mejora." Doctoral thesis, Universitat de Barcelona, 2016. http://hdl.handle.net/10803/398951.
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INTRODUCCIÓN: Los incidentes de medicación son los más frecuentes relacionados con la asistencia. Los pacientes pediátricos y los Servicios de Urgencias son especialmente susceptibles. La mayoría de incidentes son prevenibles, por lo que hablamos de errores. Los errores de prescripción son los errores de medicación más frecuentes. Éstos pueden ser de dosis, indicación y vía de administración. Según la gravedad pueden ser leves, moderados o graves. El mayor nivel de urgencia, el menor nivel de experiencia del facultativo, la menor edad del paciente, los días festivos y el horario nocturno pueden favorecer la aparición de errores. Se proponen diferentes estrategias preventivas para reducir los errores de medicación.
HIPÓTESIS:
A. El registro y posterior revisión de los errores de medicación permitirán conocer su epidemiología y los factores que influyen en su producción.
B. La aplicación de medidas preventivas a partir de esta revisión y la información derivada de la misma, permitirá una reducción en los errores.
METODOLOGÍA Y RESULTADOS:
Para verificar las hipótesis de trabajo se han realizado 5 estudios:
* Dos estudios de revisión de incidentes de medicación:
1. Un estudio observacional retrospectivo donde se revisaron todas las prescripciones administradas en el Servicio de Urgencias Pediátrico (SUP) del 1 al 7 de noviembre de 2007. El porcentaje total de errores de medicación detectados oscila entre 8,6-15%. Los fármacos que dieron lugar a más errores fueron los de más uso en urgencias: broncodilatadores y antiinflamatorios. Los errores más frecuentes fueron los de dosis seguidos por los de indicación. La mayor parte de los errores fueron leves. Los factores favorecedores fueron las noches (0-8 horas)y los días festivos.
2. Una revisión de los errores de medicación y estrategias de prevención en los SUP.
* Tres estudios antes y después de la aplicación de una estrategia preventiva de incidentes:
3. La implementación de un nuevo sistema informático (mayo 2009) no supuso ni aumento ni disminución del número total de errores. Se observó una disminución significativa de errores de indicación coincidiendo también con la aplicación de una campaña para la mejora en el tratamiento del dolor en urgencias. El conocimiento previo de los errores y la formación en el nuevo programa compensaron el efecto de la implantación del nuevo sistema, evitando incrementar errores.
4. La difusión de los errores más frecuentes y la colocación de carteles con recomendaciones para evitarlos y con las dosis de los fármacos más susceptibles (durante el 2010) permitieron una reducción de errores de dosis, por las noches y en los pacientes más urgentes.
5. La implantación de un nuevo modelo de declaración de incidentes (mayo 2012) logró un incremento de hasta 5 veces más en las declaraciones respecto al año anterior. Las causas contribuyentes más habituales fueron factores individuales del profesional, de formación y de condiciones de trabajo. A partir de los incidentes declarados surgieron múltiples medidas de mejora que se fueron implantando.
CONCLUSIONES:
* Los tipos de incidentes de medicación más frecuentes en los SUP son los de prescripción. La presión asistencial favorece su aparición, dificulta la comunicación y predispone a las distracciones.
* La reducción de la duración de los turnos de trabajo, la utilización de sistemas informáticos adecuados y la participación de los pacientes en el acto asistencial son medidas que pueden aminorar su aparición.
* El conocimiento de los posibles incidentes relacionados con la implantación de un nuevo sistema informático permite una formación previa de los profesionales que minimiza su aparición.
* La difusión de los errores más frecuentes a través de carteles con recomendaciones y la realización de sesiones presenciales formativas son eficaces para reducir errores de medicación.
* La implantación de un modelo de declaración de incidentes genera un aumento significativo del número de declaraciones fundamentalmente a expensas de notificaciones de errores de medicación.
* La introducción de la Cultura de Seguridad tiene un impacto positivo e irrenunciable en la atención del paciente en un Servicio de Urgencias.INTRODUCTION Medication incidents are the most frequent related to assistance. Prescription errors such as dosing, indication and administration route are the most common. According to its severity they are classified as mild, moderate and serious. Higher emergency level, lower experience of physician, younger is the patient, holidays and night shift can facilitate errors to occur. Preventive strategies are proposed. HYPOTHESIS * Registration and revision of medication errors would permit knowing their epidemiology and favoring factors. * The application of preventive measures originated of this revision would allow cutting down with errors. METODOLOGY AND RESULTS To verify work hypothesis 5 articles are developed: 1. A retrospective study, where prescriptions administered at the Pediatric Emergency Department (PED) are rechecked during first week November 2007. Percentage of medication errors was 15%. Most usual errors are dosing and indication. Most of them were mild. Favoring factors were nights (0am-8am) and holidays. 2. A revision of medication errors and preventive strategies at the PED. 3. The implementation of a new software (May 2009) does not increase errors. Indication errors are reduced at the same time with a campaign to improve pain treatment at PED. 4. The diffusion of most frequent errors and the placement of recommendation posters with measures to prevent them and others with the doses of most susceptible drugs (during 2010) lead to a decrease of dosing errors, night errors and in the most urgent patients. 5. The application of a new declaring incidents model (May 2012) achieves an increment of 5 times in declaration compared to previous year. Most habitual contributory causes are individual factors, training and work conditions. From the detected incidents multiple improvement measures are implemented. CONCLUSIONS * Prescriptions are the most frequent medication incidents in the PED. Assistance pressure facilitates their appearance, complicates communication and favors distractions. * Reducing work shifts, implementing adequate software and introducing patients into the care act can minimize errors. * The knowledge of risk factors and the use of preventive measures before the introduction of a new software allows cutting down with errors. * Diffusion of most frequent errors with recommendation posters and educational classroom sessions, it is an efficient way to reduce medication errors. * The implementation of a new incidents declaration model leads to a significant increment of declarations, especially of medication errors notifications. * The introduction of Patient Safety Culture has a positive and inalienable impact in patient assistance at PED.
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Walsh, Marie Helen. "Automated Medication Dispensing Cabinet and Medication Errors." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/305.
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The number of deaths due to medical errors in hospitals ranges from 44,000 to 98,000 yearly. More than 7,000 of these deaths have taken place due to medication errors. This project evaluated the implementation of an automated medication dispensing cabinet or PYXIS machine in a 25-bed upper Midwestern critical access hospital. Lewin's stage theory of organizational change and Roger's diffusion of innovations theory supported the project. Nursing staff members were asked to complete an anonymous, qualitative survey approximately 1 month after the implementation of the PYXIS and again 1 year later. Questions were focused on the device and its use in preventing medication errors in the hospital. In addition to the surveys that were completed, interviews were conducted with the pharmacist, the pharmacy techs, and the director of nursing 1 year after implementation to ascertain perceptions of the change from paper-based medication administration to use of the automated medication dispensing cabinet. Medication errors before, during, and after the PYXIS implementation were analyzed. The small sample and the small number of medication errors allowed simple counts and qualitative analysis of the data. The staff members were generally satisfied with the change, although they acknowledged workflow disruption and increased medication errors. The increase in medication errors may be due in part to better documentation of errors during the transition and after implementation. Social change in practice was supported through the patient safety mechanisms and ongoing process changes that were put in place to support the new technology. This project provides direction to other critical access hospitals regarding planning considerations and best practices in implementing a PYXIS machine.
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Devney, Anne Marie. "Effect of interactive video practice in detecting technical errors on performance of a simple medical procedure." Thesis, San Diego State University, 1985. http://hdl.handle.net/10945/21292.
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Thomas, Ruth. "Test of a Smock System on CPR Primary Emergency Measures and Medical Errors During Simulated Emergencies." FIU Digital Commons, 2012. http://digitalcommons.fiu.edu/etd/759.
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Rates of survival of victims of sudden cardiac arrest (SCA) using cardio pulmonary resuscitation (CPR) have shown little improvement over the past three decades. Since registered nurses (RNs) comprise the largest group of healthcare providers in U.S. hospitals, it is essential that they are competent in performing the four primary measures (compression, ventilation, medication administration, and defibrillation) of CPR in order to improve survival rates of SCA patients. The purpose of this experimental study was to test a color-coded SMOCK system on:1) time to implement emergency patient care measures 2) technical skills performance 3) number of medical errors, and 4) team performance during simulated CPR exercises. The study sample was 260 RNs (M 40 years, SD=11.6) with work experience as an RN (M 7.25 years, SD=9.42).Nurses were allocated to a control or intervention arm consisting of 20 groups of 5-8 RNs per arm for a total of 130 RNs in each arm. Nurses in each study arm were given clinical scenarios requiring emergency CPR. Nurses in the intervention group wore different color labeled aprons (smocks) indicating their role assignment (medications, ventilation, compression, defibrillation, etc) on the code team during CPR. Findings indicated that the intervention using color-labeled smocks for pre-assigned roles had a significant effect on the time nurses started compressions (t=3.03, p=0.005), ventilations (t=2.86, p=0.004) and defibrillations (t=2.00, p=.05) when compared to the controls using the standard of care. In performing technical skills, nurses in the intervention groups performed compressions and ventilations significantly better than those in the control groups. The control groups made significantly (t=-2.61, p=0.013) more total errors (7.55 SD 1.54) than the intervention group (5.60, SD 1.90). There were no significant differences in team performance measures between the groups. Study findings indicate use of colored labeled smocks during CPR emergencies resulted in: shorter times to start emergency CPR; reduced errors; more technical skills completed successfully; and no differences in team performance.
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Feng, Yunyi. "Identification of Medical Coding Errors and Evaluation of Representation Methods for Clinical Notes Using Machine Learning." Ohio University / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1555421482252775.
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Skaria, Rinku Saju. "Medical Errors in the Operating Room Attributable to Communication Breakdown and its Effects on Patient Safety." Thesis, The University of Arizona, 2014. http://hdl.handle.net/10150/321958.
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Vile, Douglas J. "Statistical modeling of interfractional tissue deformation and its application in radiation therapy planning." VCU Scholars Compass, 2014. http://scholarscompass.vcu.edu/etd/3675.
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In radiation therapy, interfraction organ motion introduces a level of geometric uncertainty into the planning process. Plans, which are typically based upon a single instance of anatomy, must be robust against daily anatomical variations. For this problem, a model of the magnitude, direction, and likelihood of deformation is useful. In this thesis, principal component analysis (PCA) is used to statistically model the 3D organ motion for 19 prostate cancer patients, each with 8-13 fractional computed tomography (CT) images. Deformable image registration and the resultant displacement vector fields (DVFs) are used to quantify the interfraction systematic and random motion. By applying the PCA technique to the random DVFs, principal modes of random tissue deformation were determined for each patient, and a method for sampling synthetic random DVFs was developed.
The PCA model was then extended to describe the principal modes of systematic and random organ motion for the population of patients. A leave-one-out study tested both the systematic and random motion model’s ability to represent PCA training set DVFs. The random and systematic DVF PCA models allowed the reconstruction of these data with absolute mean errors between 0.5-0.9 mm and 1-2 mm, respectively. To the best of the author’s knowledge, this study is the first successful effort to build a fully 3D statistical PCA model of systematic tissue deformation in a population of patients.
By sampling synthetic systematic and random errors, organ occupancy maps were created for bony and prostate-centroid patient setup processes. By thresholding these maps, PCA-based planning target volume (PTV) was created and tested against conventional margin recipes (van Herk for bony alignment and 5 mm fixed [3 mm posterior] margin for centroid alignment) in a virtual clinical trial for low-risk prostate cancer. Deformably accumulated delivered dose served as a surrogate for clinical outcome. For the bony landmark setup subtrial, the PCA PTV significantly (p30, D20, and D5 to bladder and D50 to rectum, while increasing rectal D20 and D5. For the centroid-aligned setup, the PCA PTV significantly reduced all bladder DVH metrics and trended to lower rectal toxicity metrics. All PTVs covered the prostate with the prescription dose.
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Ding, Chunyan, and 丁春艳. "Medical negligence law in transitional China: a patient in need of a cure." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B43913696.
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Denny, Diane. "Medical Error Reporting and Patient Safety: An Exploration of Our Underreporting Dilemma." Diss., Temple University Libraries, 2017. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/427730.
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Business Administration/InterdisciplinaryPh.D.
Studies suggest that the majority of hospital errors go unreported. Equally disturbing is that data surrounding near miss events that could have harmed patients has been found to be even sparser. At the core of any medical error reporting effort is a desire to obtain data that can be used to reduce the frequency of errors, reveal the cause of errors, and empower those involved in the healthcare delivery system with the insight required to design methods to prevent the flaws that allow mistakes to occur. Aligned with the adage that “we can’t fix what we don’t know is broke”, the question is raised why does underreporting exist? The likelihood of reporting medical errors is explored as a manifestation of culture. Factors studied include communication and feedback, teamwork, fear of retribution, and leadership support (top management and supervisor). Data is presented using a nationally recognized instrument—the Agency for Healthcare Research and Quality (AHRQ) Culture of Safety survey. Findings from the research are mixed with little positive relationship between the model and number of events reported although each factor is found to be positively associated with an employee’s perceived frequency by which near miss and no harm events are reported. While advances in patient safety have materialized, the act of employees’ actually reporting events still pales in comparison to the number of errors that have likely occurred, regardless of efforts to advance culture. To explore influencers beyond those found in the AHRQ Culture of Safety survey, an overlapping model is presented. This includes studying various underlying factors, such as understanding what constitutes a reportable event, ease of reporting, and knowledge of the processes supporting data submission, along with attempting to better assess the impact of the direct supervisor and incentives in influencing behavior. Findings suggest that these additional factors do contribute, albeit modestly, to the act of reporting errors. When adding tenure and patient interaction to the model, a higher percentage of the variance is explained. In terms of perceived frequency of reporting near misses and no harm events, this model yields similar results to the first, explaining approximately 28% of the variance. The two factors most positively associated with perceived frequency of reporting near miss and no harm events are communication and feedback and infrastructure —suggesting that some unexplored relationship may exist between the overlapping models.
Temple University--Theses
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Krecu, N., M. Gnatiuk, and O. Kuhta. "RISK ASSESSMENT OF DYSFUNCTIONAL GROUPS IN PROBLEM-BASED LEARNING SESSIONS IN PROJECT OF MEDICAL ERRORS PREVENTION (TAME)." Thesis, Матеріали ІV Міжнародного медико-фармацевтичного конгресу студентів і молодих учених [«Пріоритети і перспективи молодіжної науки»] BIMCO 2017, 2017. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/12926.
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Bogutska, N. K. "Adaptation process of inmplementation of the project «tame» (training against medical errors, erasmus+) to traditional pediatric curriculum." Thesis, Матеріали навчально-методичної конференції [“Актуальні питання вищої медичної та фармацевтичної освіти: досвід, проблеми, інновації та сучасні технології”], 2017. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/13151.
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Quiles, Rolando. "Challenges of implementing RSS barcodes on hospital unit dose blisters /." Online version of thesis, 2007. http://hdl.handle.net/1850/5468.
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Junior, João Baptista Opitz. "Erro médico em cirurgia do aparelho digestivo: contribuição para o estudo das provas técnicas, periciais e documentais e suas implicações jurídicas." Universidade de São Paulo, 2005. http://www.teses.usp.br/teses/disponiveis/5/5154/tde-04042007-080142/.
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Neste trabalho foram analisados trinta processos judiciais, que tramitam pelos Fóruns Regionais Cíveis de São Paulo, capital e interior e Instituições Periciais da Capital. Fez-se as extrações individualizadas de cada processo, objetivando definir as principais causas e documentos juntados ao mesmo e conseqüências de cada condição. Iniciou-se pela importância prática do tema para efeito de evolução médico-social. Buscou-se estudar a visão da relação médico-paciente, mesmo durante a demanda, a informação ao paciente e seus familiares dos procedimentos e limitadores do ato médico; o documental técnico jurídico juntado ao processo; o preparo técnico-jurídico do médico e, se, a propositura de ação depende da formação e especialização do profissional. Foram analisados processos judiciais de primeira instância no período de 1996 a 2002 correlacionados à cirurgias do aparelho digestivo. Usou-se como parâmetro de análise exclusivamente os documentos juntados aos autos onde buscou-se a existência clara da quebra da relação médico-paciente, a existência de consentimento informado, a verificação do documental juntado à defesa pelas partes ou solicitação judicial e a qualificação do profissional envolvido nas ações. Finalmente, analisados os resultados, chegamos a conclusão que a melhor forma para profilaxia da ação cível indenizatória por erro médico é: a boa relação médico-paciente; a manutenção de prontuário médico preenchido, legível, com carimbo e assinatura; o consentimento informado, que, deve ser elaborado, porém, por si só não é suficiente; e a condição técnico curricular do profissional não é fator atenuante para propositura da ação.Thirty legal proceedings, which are in progress before the Regional Civil Courts both the Capital and the countryside of the State of Sao Paulo, Brazil, besides Examination Institutions in the Capital city of Sao Paulo, have been analyzed in this work Individual excerpts of each case were taken with the purpose of defining the main causes and documentation attached to them as well the consequences of each condition. The practical importance of the subject for the medical-social evolution has been addressed in the first place. The physician/patient relationship view was sought to be studied, even during the claim, as well as the information of the medical procedures and limitations to the patient and his or her family; the technical/legal documentation attached to the case; the physician technical/legal preparation and whether the filing of the action depends on the professional education and specialization. Trial court cases from 1996 to 2002 related to digestive system surgery have been analyzed. The analysis subject hereof has been based exclusively on the documents attached to the case record, where attempts have been made to evidence the clear existence of the breach of the physician/patient relationship, the existence of informed consent, the examination of the documentation attached to the defense by the parties or court request, and the qualification of the professional involved in the actions. Finally, after the results have been analyzed, a conclusion was reached that the best way of avoiding a civil action for damages due to medical malpractice includes: a good relationship between doctors and patients; keeping the patient record completed, legible, stamped, and signed; informed consent, which must be prepared but it is not sufficient on its own; and the professional technical experience and background do not constitute a mitigating circumstance for filing the action.
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Picoli, Fernando Fortes. "Análise das jurisprudências sobre alegado erro odontológico em tratamentos ortodônticos no Brasil." Universidade Federal de Goiás, 2017. http://repositorio.bc.ufg.br/tede/handle/tede/7193.
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Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG
Once the dentist is inserted in a social context, his professional performance is mediated by laws that may require compensation, as financial claims, for the damages caused to the patients. The literature has pointed out a significant increase in the lawsuits that dentists are involved, being orthodontics among the specialties most enrolled in these litigations. This study aimed to analyze the judicial decisions on second instance that involved Orthodontics in alleged dental error in Brazil. An online search was done on the virtual pages of the Courts of Justice of the Brazilian states and the Federal District, searching for decisions that were published until December 31st, and that had the orthodontic treatment as central focus. The following keywords were used in the search: erro AND odontológico; erro AND odontologia; ortodontia; aparelho AND dentário; dentário; ortodôntico. Data regarding the profile of the parties, monetary amounts involved, contractual obligation, type of civil liability considered and the judgments of judicial decisions were collected. A total of 319 judgments that were in line with the scope of research were found, and in 38.6% of them, the main reason for initiating the lawsuit was dissatisfaction with the orthodontic treatment. In 52.4% of the cases, there was absolution of the dentist. The conviction in the first instance and the fact that orthodontic treatment was considered as a contractual obligation of result had a statistically significant influence (p <0.05) on the conviction frequencies of the professionals in the second instance. Through this study, it can be concluded that, in Brazil, most patients who demand dentists for malpractice in orthodontic therapy claimed to be dissatisfied with the treatment outcome. The conviction on the singular jury decision and the contractual obligation of the Orthodontics influenced the frequency of second-degree convictions.
Estando o cirurgião-dentista inserido no contexto social, sua atuação profissional também é mediada por normas jurídicas que podem exigir que os danos causados aos pacientes sejam ressarcidos na forma de indenizações. A literatura tem apontado um incremento significativo nas ações judiciais que cirurgiões-dentistas são demandados, estando a Ortodontia entre as especialidades mais envolvidas nessas lides. Este trabalho teve como objetivo analisar as decisões judiciais de segunda instância que envolviam a Ortodontia em alegado erro odontológico no Brasil. Para tanto, foram feitas pesquisas nas páginas virtuais dos Tribunais de Justiça dos estados brasileiros e do Distrito Federal, com o auxílio da internet, buscando por decisões publicadas até 31 de dezembro de 2015 e que tivessem como cerne da lide o tratamento ortodôntico. Foram utilizadas as palavras chave associadas a operador booleano: erro E odontológico; erro E odontologia; ortodontia; aparelho E dentário; dentário; ortodôntico. Dados relativos ao perfil das partes, valores monetários envolvidos, obrigação contratual, tipo de responsabilidade civil considerada e as sentenças das decisões judiciais foram coletados. Encontrou-se 319 acórdãos que atendiam ao escopo do trabalho, sendo que em 38,6% deles, o motivo alegado para instauração dos processos foi a insatisfação com o tratamento. Em 52,4% dos casos, houve absolvição do cirurgião-dentista. A condenação em primeira instância e o fato do tratamento ortodôntico ter sido considerado como obrigação contratual de resultado influenciaram de forma estatisticamente significante (p<0,05) nas frequências de condenações dos profissionais em segunda instância. Por meio deste trabalho, pode-se concluir que a maior parte dos pacientes que processam os cirurgiões-dentistas por insatisfação com tratamento ortodônticos no Brasil alegaram estar insatisfeitos com o resultado do tratamento, sendo que a sentença condenatória em primeiro grau e a obrigação contratual da Ortodontia influenciaram na frequência de sentenças condenatórias em segundo grau.
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Grollmes, Deborah N. "Reduction of aberrant medical errors through United States Navy standardized militaristic training techniques in combination with technological innovations." Honors in the Major Thesis, University of Central Florida, 2001. http://digital.library.ucf.edu/cdm/ref/collection/ETH/id/224.
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This item is only available in print in the UCF Libraries. If this is your Honors Thesis, you can help us make it available online for use by researchers around the world by following the instructions on the distribution consent form at http://library.ucf.edu/Systems/DigitalInitiatives/DigitalCollections/InternetDistributionConsentAgreementForm.pdf You may also contact the project coordinator, Kerri Bottorff, at kerri.bottorff@ucf.edu for more information.Bachelors
Health and Public Affairs
Health Services Administration
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Wallin, Olof. "Preanalytical errors in hospitals : implications for quality improvement of blood sample collection." Doctoral thesis, Umeå universitet, Institutionen för medicinsk biovetenskap, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1672.
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Background: Most errors in the venous blood testing process are preanalytical, i.e. they occur before the sample reaches the laboratory. Unlike the laboratory analysis, the preanalytical phase involves several error-prone manual tasks not easily avoided with technological solutions. Despite the importance of the preanalytical phase for a correct test result, little is known about how blood samples are collected in hospitals. Aim: The aim of this thesis was to survey preanalytical procedures in hospitals to identify sources of error. Methods: The first part of this thesis was a questionnaire survey. After a pilot study (Paper I), a questionnaire addressing clinical chemistry testing was completed by venous blood sampling staff (n=314, response rate 94%) in hospital wards and hospital laboratories (Papers II–IV). The second part of this thesis was an experimental study. Haematology, coagulation, platelet function and global coagulation parameters were compared between pneumatic tube-transported samples and samples that had not been transported (Paper V). Results: The results of the questionnaire survey indicate that the desirable procedure for the collection and handling of venous blood samples were not always followed in the wards (Papers II–III). For example, as few as 2.4% of the ward staff reported to always label the test tube immediately before sample collection. Only 22% of the ward staff reported to always use wristbands for patient identification, while 18% reported to always use online laboratory manuals, the only source of updated information. However, a substantial part of the ward staff showed considerable interest in re-education (45%) and willingness to improve routines (44%) for venous blood sampling. Compared to the ward staff, the laboratory staff reported significantly higher proportions of desirable practices regarding test request management, test tube labelling, test information search procedures, and the collection and handling of venous blood samples, but not regarding patient identification. Of the ward staff, only 5.5% had ever filed an error report regarding venous blood sampling, compared to 28% of the laboratory staff (Paper IV). In the experimental study (Paper V), no significant preanalytical effect of pneumatic tube transport was found for most haematology, coagulation and platelet function parameters. However, time-to-clot formation was significantly shorter (16%) in the pneumatic tube-transported samples, indicating an in vitro activation of global coagulation. Conclusions. The questionnaire study of the rated experiences of venous blood sampling ward staff is the first of its kind to survey manual tasks in the preanalytical phase. The results suggest a clinically important risk of preanalytical errors in the surveyed wards. Computerised test request management will eliminate some, but not all, of the identified risks. The better performance reported by the laboratory staff may reflect successful quality improvement initiatives in the laboratories. The current error reporting system needs to be functionally implemented. The experimental study indicates that pneumatic tube transport does not introduce preanalytical errors for regular tests, but manual transport is recommended for analysis with thromboelastographic technique. This thesis underscores the importance of quality improvement in the preanalytical phase of venous blood testing in hospitals.
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Cunningham, Thomas Raymond. "A comprehensive approach to preventing errors in a hospital setting: Organizational behavior management and patient safety." Diss., Virginia Tech, 2009. http://hdl.handle.net/10919/26279.
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Estimates of the number of U.S. deaths each year resulting from medical errors range from 44,000 (Institute of Medicine, 1999) to 195,000 (HealthGrades, 2004). Additionally, instances of medical harm are estimated to occur at a rate of approximately 15 million per year in the U.S., or about 40,000 per day (Institute for Healthcare Improvement, 2007).
Although several organizational behavior management (OBM) intervention techniques have been used to improve particular behaviors related to patient safety, there remains a lack of patient-safety-focused behavioral interventions among healthcare workers. OBM interventions are often applied to needs already identified within an organization, and the means by which these needs are determined vary across applications. The current research addresses gaps in the literature by applying a broad needs-assessment methodology to identify patient-safety intervention targets in a hospital and then translating OBM intervention techniques to identify and improve the prevention potential of responses to reported medical errors.
A content analysis of 17 months of descriptions of follow-up actions to error reports for nine types of the most-frequently-occurring errors was conducted. Follow-up actions were coded according to a taxonomy of behavioral intervention components, with accompanying prevention scores based on criteria developed by Geller et al. (1990). Two error types were selected for intervention; based on the highest frequency of reporting and lowest average follow-up prevention score. Over a three-month intervention period, managers were instructed to respond to these two error types with active communication, group feedback, and positive reinforcement strategies.
Results indicate improved prevention potential as a consequence of improved corrective action for targeted errors. Future implications for identifying and classifying responses to medical error are discussed.Ph. D.
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Mousa, Ahmad. "Nurse staffing, patient falls and medication errors in Western Australian hospitals: Is there a relationship?" Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2017. https://ro.ecu.edu.au/theses/1998.
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Background: According to the Australian Bureau of Statistics (2013) falls and medication errors in hospitals are among the first twenty leading causes of death. Research on the relationship between nurse staffing, patient falls, and medication errors are limited. Even scarcer are studies that examine this relationship on a nursing shift by shift and ward by ward basis, and no research exists on shift overlap periods and adverse patient outcomes.
Objective: This study examined whether there was a relationship between hospital inpatient falls and medication errors and nurse staffing on a shift by shift and ward by ward basis, including an analysis of patient characteristics and the severity of incidents.
Research Design: Multinomial logistic regression models were used. Data were collected using a secondary analysis of two existing databases: Advanced Incident Management System (AIMS) database and the nursing staff roster database (RoSTAR) over two years (January 2011 to December 2012). The Kane framework of nurse staffing was used to guide the current study.
Setting: The study was conducted in three adult tertiary teaching hospitals in Perth, Western Australia.
Participants: Reports of 7,558 incidents that occurred during the study period from 76 nursing wards and wards (4,677 medical, 2,209 surgical, and 672 critical care wards incidents), and 320,009 nursing shift records in three hospitals, were examined.
Measures: The occurrence and severity of shift-level inpatient falls and medication errors were measured as dependent variables. Independent variables included nursing staff skill-mix, staff experience, and actual nursing hours. Control variables were shift, ward type, and hospital.
Results: This study supports the importance of RN staffing levels in improving patient outcomes. However, it also shows that the relationship between nurse staffing and patient outcomes can be affected by different factors such as patient characteristics, nurse characteristics, and ward type. The number of total clinical incident reports decreased by 7.4% from 2011 to 2012. Falls declined by 4.6% and medication errors declined by 10.8%. The average age of patients who fell or had medication errors was 56.3 years (range of 15 to 100 years) but was more common in patients over 65 years old (57.3%). The number of incidents was highest during the morning shift, less during the evening and lowest during the night shift (28.4%, 27.2%, and 21.8% respectively). Notably, 22.6% of total incidents were reported during the overlap period (13:00 pm to 15:29 pm) which is only two and a half hours. Medical wards had the highest incident records followed by surgical wards; fewer incidents occurred in critical care wards (61.9%, 29.2%, and 8.9% respectively). More registered nurses and more experienced staff on the shift were both associated with fewer falls and medication error incidents, as well as less severe injuries. An increase in the actual nursing hours was associated with fewer medication errors but not fewer fall incidents. However, an increase in in the actual nursing hours was associated with less severe falls but not less severe medication errors.
Conclusion: Overall, the fall and medication error incidents in three Perth hospitals decreased over the study period. However, the large variation in the incidents at both the shift and the ward level indicated room for improvement related to fall and medication error prevention. A relationship was identified between both more RNs and more experienced nurses in attendance and fewer incidents and less severe injuries. Further studies are necessary to identify prevention strategies for hospital falls and medication errors in the overlap period. Immediate consideration of the number of incidents that occurred during the overlap period is required. It is necessary to improve communication and teamwork among staff. Actions should be taken to review, implement and evaluate policies and procedures.
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Junior, João Baptista Opitz. "Análise crítica de decisões e acordos em processos cíveis de erro médico em cirurgias do aparelho digestivo." Universidade de São Paulo, 2007. http://www.teses.usp.br/teses/disponiveis/5/5154/tde-13102010-152210/.
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Este trabalho tenta colocar em evidência dois pontos dos mais atuais, tanto na área da Medicina como no Direito: a falha técnica e a correspondente reparação do dano por ela causado. Para o desenvolvimento deste trabalho, foram utilizados processos judiciais de primeira instância no período de 1995 a 2003 correlacionados às cirurgias do aparelho digestivo. Buscou-se definir os perfis dos médicos mais processados, que pagam maiores valores indenizatórios, bem como de outro lado os pacientes que mais processam e mais recebem valores indenizatórios, nos processos analisados. Os parâmetros, principais de análise foram as sentenças proferidas em primeira instância, em casos de condenação do médico e os respectivos valores envolvidos. Finalmente concluímos que: O perfil do paciente que mais processa médico: 41 a 60 anos, branco, feminino, católico com nível superior e detentor de justiça gratuita. O perfil do paciente recebe maiores valores médios indenizatórios: 41 a 60 anos, negro, feminino, católico, ensino fundamental e detentor de justiça gratuita. O perfil do médico que é mais processado por erro médico em Cirurgia do Aparelho Digestivo: 41 a 60 anos, branco, masculino, com título de especialista, formado entre 21 a 30 anos, no atendimento de convênio de plano de saúde, não possuindo seguro profissional, em atendimento de urgência/emergência e em equipe multidisciplinar. O perfil do médico que paga maiores valores indenizatórios em processos por erro médico em Cirurgia do Aparelho Digestivo: 21 a 40 anos, branco, masculino, residente, em atendimento em hospital público, não possuindo seguro profissional, em atendimento de urgência/emergência e em equipe multidisciplinar.This works attempts to highlight two of the most current points, both in the fields of Medicine and Law: technical failure and the corresponding repair of the damage caused by it. For the development of this work, trial-court level proceedings in the period from 1995 to 2003 related to digestive system surgeries were used. The intention was to define the profile of the most prosecuted physicians, who pay the highest indemnification amounts, as well as, on the other hand, the patients that prosecute them most and receive indemnification amounts the most, in the reviewed proceedings. The main parameters for analysis were the judgments issued at trial-court level, in cases of conviction of the physician and the corresponding amounts involved. Finally, we concluded that: The profile of the patient who prosecutes the physician the most: 41 to 60 years old, Caucasian, female, catholic with higher education and entitled to free-of-charge justice. The profile of the patient who receives the highest average indemnity amount: 41 to 60 years old, black, female, catholic with primary education and entitled to free-of-charge justice. The profile of the physician who is prosecuted the most for medical error in a Surgery of the Digestive System: 41 to 60 years old, Caucasian, male, with a specialist degree, graduated between 21 and 30 years old, operating with health care insurance, and not holding professional insurance, in cases of urgency/emergency and in a multi-disciplinary team. The profile of the physician who pays the highest indemnity amounts in cases of medical error in a Surgery of the Digestive System: 21 to 40 years old, Caucasian, male, resident, working at a public hospital, not holding professional insurance, in cases of urgency/emergency and in a multi-disciplinary team.