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Biomedical subjects

Nancy C Elder

Publications and source records attributed to Nancy C Elder.

9 recordsLinked to original sources
PubMed2006

What do family physicians consider an error? A comparison of definitions and physician perception.

BACKGROUND: Physicians are being asked to report errors from primary care, but little is known about how they apply the term "error." This study qualitatively assesses the relationship between the variety of error definitions found in the medical literature and physicians' assessments of whether an error occurred in a series of clinical scenarios. METHODS: A systematic literature review and pilot survey results were analyzed qualitatively to search for insights into what may affect the use of the term error. The National Library of Medicine was systematically searched for medical error definitions. Survey participants were a random sample of active members of the American Academy of Family Physicians (AAFP) and a selected sample of family physician patient safety "experts." A survey consisting of 5 clinical scenarios with problems (wrong test performed, abnormal result not followed-up, abnormal result overlooked, blood tube broken and missing scan results) was sent by mail to AAFP members and by e-mail to the experts. Physicians were asked to judge if an error occurred. A qualitative analysis was performed via "immersion and crystallization" of emergent insights from the collected data. RESULTS: While one definition, that originated by James Reason, predominated the literature search, we found 25 different definitions for error in the medical literature. Surveys were returned by 28.5% of 1000 AAFP members and 92% of 25 experts. Of the 5 scenarios, 100% felt overlooking an abnormal result was an error. For other scenarios there was less agreement (experts and AAFP members, respectively agreeing an error occurred): 100 and 87% when the wrong test was performed, 96 and 87% when an abnormal test was not followed up, 74 and 62% when scan results were not available during a patient visit, and 57 and 47% when a blood tube was broken. Through qualitative analysis, we found that three areas may affect how physicians make decisions about error: the process that occurred vs. the outcome that occurred, rare vs. common occurrences and system vs. individual responsibility. CONCLUSION: There is a lack of consensus about what constitutes an error both in the medical literature and in decision making by family physicians. These potential areas of confusion need further study.

Attitude of Health Personnel↗
PubMed2006

The art of observation: impact of a family medicine and art museum partnership on student education.

BACKGROUND AND OBJECTIVES: Compared to verbal communication, teaching the skill of observation is often shortchanged in medical education. Through a family medicine-art museum collaboration, we developed an elective course for second-year medical students titled the "Art of Observation" (AOO). To evaluate the course's effect on clinical skills, we performed a qualitative evaluation of former students during their clinical rotations. METHODS: In the spring of 2005, all students who had completed the AOO course in 2003 or 2004 were invited to take part in an online evaluation consisting of eight journaling survey questions. Students were instructed to answer the survey questions with specific examples. Question areas included the most memorable experience, the course's influence on the doctor-patient relationship, usefulness during clinical years of medical school, and skills unique to AOO. The anonymous data were analyzed qualitatively, coding the responses to categories derived from the data, leading to the formation of themes. RESULTS: Of the 19 students eligible, 17 participated. We found three important themes: (1) the AOO positively influenced clinical skills, (2) both art museum exercises and a clinical preceptorship were necessary to achieve those skills, and (3) the AOO led to a sense of personal development as a physician. In addition, students told us that the training in observation and description skills they learned were unique to the AOO. CONCLUSIONS: This collaboration between a department of family medicine and an art museum produced a course that facilitated observational skills used in successful doctor-patient relationships.

Art↗
PubMed2005

Issues and initiatives in the testing process in primary care physician offices.

BACKGROUND: Errors occur frequently in management of the testing process in primary care physicians' offices. These errors may result in significant harm to patients and lead to inefficient practice. Important issues are summarized for primary care clinicians and their offices toconsider in improving the management of the testing processes. METHODS: To identify published efforts to improve management of the testing process, a literature search was performed and the references from the identified articles were checked for additional studies. Descriptive studies, expert opinion pieces, and controlled trials were all included. Unpublished results of ongoing studies in laboratory testing errors in primary care practice are presented. RESULTS: A conceptual model of the testing process was developed, with identified general and specific errors that occur in the testing process. On the basis largely of descriptive studies, ways are described to reduce testing process errors and the harm resulting from these errors. CONCLUSIONS: Standardization of processes, computerized test tracking systems (especially those embedded in electronic medical records), and attention to human factors issues are likely to reduce errors and harm. These ideas need confirmation in well-designed randomized trials and quality improvement initiatives.

Communication↗
PubMed2002

Classification of medical errors and preventable adverse events in primary care: a synthesis of the literature.

OBJECTIVE: To describe and classify process errors and preventable adverse events that occur from medical care in outpatient primary care settings. STUDY DESIGN: Systematic review and synthesis of the medical literature. DATA SOURCES: We searched MEDLINE and the Cochrane Library from 1965 through March 2001 with the MESH term medical errors, modified by adding family practice, primary health care, physicians/family, or ambulatory care and limited the search to English-language publications. Published bibliographies and Web sites from patient safety and primary care organizations were also reviewed for unpublished reports, presentations, and leads to other sites, journals, or investigators with relevant work. Additional papers were identified from the references of the papers reviewed and from seminal papers in the field. OUTCOMES MEASURED: Process errors and preventable adverse events. RESULTS: Four original research studies directly studied and described medical errors and adverse events in primary care, and 3 other studies peripherally addressed primary care medical errors. A variety of quantitative and qualitative methods were used in the studies. Extraction of results from the studies led to a classification of 3 main categories of preventable adverse events: diagnosis, treatment, and preventive services. Process errors were classified into 4 categories: clinician, communication, administration, and blunt end. CONCLUSIONS: Original research on medical errors in the primary care setting consists of a limited number of small studies that offer a rich description of medical errors and preventable adverse events primarily from the physician's viewpoint. We describe a classification derived from these studies that is based on the actual practice of primary care and provides a starting point for future epidemiologic and interventional research. Missing are studies that have patient, consumer, or other health care provider input.

Adverse Drug Reaction Reporting Systems↗
PubMedDate not supplied

The identification of medical errors by family physicians during outpatient visits.

BACKGROUND: We wanted to describe errors and preventable adverse events identified by family physicians during the office-based clinical encounter and to determine the physicians' perception of patient harm resulting from these events. METHOD: We sampled Cincinnati area family physicians representing different practice locations and demographics. After each clinical encounter, physicians completed a form identifying process errors and preventable adverse events. Brief interviews were held with physicians to ascertain their perceptions of harm or potential harm to the patient. RESULTS: Fifteen physicians in 7 practices completed forms for 351 outpatient visits. Errors and preventable adverse events were identified in 24% of these visits. There was wide variation in how often individual physicians identified errors (3% to 60% of visits). Office administration errors were most frequently noted. Harm was believe to have occurred as a result of 24% of the errors, and was a potential in another 70%. Although most harm was believed to be minor, there was disagreement as to whether to include emotional discomfort and wasted time as patient harm. CONCLUSIONS: Family physicians identify errors and preventable adverse events frequently during patient visits, but there is variation in how some error categories are interpreted and how harm is defined.

Clinical Competence↗
PubMedDate not supplied

How experiencing preventable medical problems changed patients' interactions with primary health care.

PURPOSE: We wanted to explore how patients' experiences with preventable problems in primary care have changed their behavioral interactions with the health care system. METHODS: We conducted semistructured interviews with 24 primary care patients, asking them to describe their experiences with self-perceived preventable problems. We analyzed these interviews using the editing method and classified emotional and behavioral responses to experiencing preventable problems. RESULTS: Anger was the most common emotional response, followed by mistrust and resignation. We classified participants' behavioral responses into 4 categories: avoidance (eg, stop going to the doctor), accommodation (eg, learn to deal with delays), anticipation (eg, attend to details, attend to own emotions, acquire knowledge, actively communicate), and advocacy (eg, get a second opinion). CONCLUSIONS: Understanding how patients react to their experiences with preventable problems can assist health care at both the physician-patient and system levels. We propose an association of mistrust with the behaviors of avoidance and advocacy, and suggest that further research explore the potential impact these patient behaviors have on the provision of health care.

Adult↗