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Rahul K Khare

Publications and source records attributed to Rahul K Khare.

5 recordsLinked to original sources
PubMed2005

Workplace violence: a survey of emergency physicians in the state of Michigan.

STUDY OBJECTIVE: We seek to determine the amount and type of work-related violence experienced by Michigan attending emergency physicians. METHODS: A mail survey of self-reported work-related violence exposure during the preceding 12 months was sent to randomly selected emergency physician members of the Michigan College of Emergency Physicians. Work-related violence was defined as verbal, physical, confrontation outside of the emergency department (ED), or stalking. RESULTS: Of 250 surveys sent, 177 (70.8%) were returned. Six were blank (3 were from retired emergency physicians), leaving 171 (68.4%) for analysis. Verbal threats were the most common form of work-related violence, with 74.9% (95% confidence interval [CI] 68.4% to 81.4%) of emergency physicians indicating at least 1 verbal threat in the previous 12 months. Of the emergency physicians responding, 28.1% (95% CI 21.3% to 34.8%) indicated that they were victims of a physical assault, 11.7% (95% CI 6.9% to 16.5%) indicated that they were confronted outside of the ED, and 3.5% (95% CI 0.8% to 6.3%) experienced a stalking event. Emergency physicians who were verbally threatened tended to be less experienced (11.1 versus 15.1 years in practice; mean difference -4.0 years [95% CI -6.4 to -1.6 years]), as were those who were physically assaulted (9.5 versus 13.1 years; mean difference -3.6 years [95% CI -5.9 to -1.3 years]). Urban hospital location, emergency medicine board certification, or on-site emergency medicine residency program were not significantly associated with any type of work-related violence. Female emergency physicians were more likely to have experienced physical violence (95% CI 1.4 to 5.8) but not other types of violence. Most (81.9%; 95% CI 76.1% to 87.6%) emergency physicians were occasionally fearful of workplace violence, whereas 9.4% (95% CI 5.0% to 13.7%) were frequently fearful. Forty-two percent of emergency physicians sought various forms of protection as a result of the direct or perceived violence, including obtaining a gun (18%), knife (20%), concealed weapon license (13%), mace (7%), club (4%), or a security escort (31%). CONCLUSION: Work-related violence exposure is not uncommon in EDs. Many emergency physicians are concerned about the violence and are taking measures, including personal protection, in response to the fear.

Emergency Service, Hospital↗
PubMed2003

Resident perceptions of medical errors in the emergency department.

OBJECTIVES: To evaluate resident experience and perceptions of medical error associated with emergency department (ED) care. METHODS: Using a semistructured interview protocol, three researchers interviewed 26 randomly selected medical, surgical, and obstetrics residents regarding medical error. The authors chose a 16-case subset of incidents involving ED care for initial review. Interview transcripts were reviewed iteratively to draw out recurrent categories and themes. Two investigators separately analyzed all cases to ensure common understanding and agreement. RESULTS: Most cases involved misdiagnosis, misread radiographs, or inappropriate disposition. Two thirds of the case patients died or experienced delays in care. Residents felt that the complexity of the patients, as well as the complexity of their own jobs, contributed to error. Attending supervision, nurse evaluation, and additional physician involvement all were noted to be important checks within the hospital system. Residents most often held the ED responsible for error. In addition, they deemed themselves, their teams, and their lack of training responsible. Though residents often discussed events with their admitting teams, follow-up with the ED or other associated individuals was uncommon. The findings revealed seven common themes that include factors contributing to errors, checks and adaptations, and follow-up of the event. CONCLUSIONS: Residents are aware of medical error and able to recall events in detail. Whereas events are discussed among inpatient teams, little information finds its way back to the ED, potentially resulting in misunderstandings between departments and hindering learning from events. In-depth interviewing allows a nuanced and detailed approach to error analysis.

Emergency Service, Hospital↗
PubMedDate not supplied

Capturing more emergency department errors via an anonymous web-based reporting system.

OBJECTIVES: It is generally understood that errors occur during patient care in the emergency department (ED). However, the errors that are reported likely represent a fraction of those that occur. Increasing the error reporting rate would allow for more opportunities to investigate the root causes of errors and improve systems design as part of a continuous quality improvement (CQI) process. We present a model Web-based system for reporting of errors that occur in patient care in the ED. METHODS: We propose a Web-based system of error reporting. Utilizing Web technology permits secure, timely, and, optionally, anonymous reporting of errors. The Web page is readily accessible to users within the medical center. Reporting may be anonymous or the reporters may identify themselves. The reports are sorted by the user and entered based on the type of error and sent to a secure database. The database can be regularly reviewed by a designated person as part of an ongoing CQI process. CQI committees should then have more useful data to reference when designing system improvements. CONCLUSIONS: A Web-based error reporting implemented in this manner may improve error reporting because of the convenience it offers and the option of anonymity. More reporting should create more opportunities for system improvement.

Communication Barriers↗