Framing family conversation after early diagnosis of iatrogenic injury and incidental findings. | PSNet

Provide Feedback |

Submit a Case

Register

Study

Framing family conversation after early diagnosis of iatrogenic injury and incidental findings.

May 6, 2009

Barrios L, Tsuda S, Derevianko A, et al. Surg Endosc. 2009;23(11):2535-42.

View more articles from the same authors.

In this study of simulated cholecystectomies, surgical residents felt ill-trained to disclose both complications (common bile duct injury) and serious incidental findings (gallbladder cancer) encountered during a cholecystectomy. Most concerning, a large proportion of residents did not adequately describe potential complications when obtaining informed consent.

PubMed citation

Related Resources From the Same Author(s)

Simulated laparoscopic operating room crisis: an approach to enhance the surgical team performance.

July 2, 2008

On the quest for Six Sigma.

April 3, 2005

Integrating simulation in surgery as a teaching tool and credentialing standard.

December 5, 2007

Improving the patient, family, and clinician experience after harmful events: the "When Things Go Wrong" curriculum.

June 16, 2010

Canadian Association of University Surgeons' Annual Symposium. Surgical simulation: the solution to safe training or a promise unfulfilled?

September 5, 2012

A systematic review of the effect of distraction on surgeon performance: directions for operating room policy and surgical training.

September 2, 2015

Seasoned surgeons assessed in a laparoscopic surgical crisis.

May 13, 2009

Fundamental Use of Surgical Energy (FUSE): an essential educational program for operating room safety.

April 5, 2017

The SAGES FUSE program: bridging a patient safety gap.

October 22, 2014

Distractions in the operating room: a survey of the healthcare team.

April 5, 2023

An overview of research priorities in surgical simulation: what the literature shows has been achieved during the 21st century and what remains.

September 23, 2015

Surgeons don't know what they don't know about the safe use of energy in surgery.

June 20, 2012

Differences in day and night shift clinical performance in anesthesiology.

June 4, 2008

Sustained effectiveness of a primary-team-based rapid response system.

July 18, 2012

Adjusting to duty hour reforms: residents' perception of the safety climate in interdisciplinary night-float rotations.

February 20, 2019

Communication practices on 4 Harvard surgical services: a surgical safety collaborative.

November 11, 2009

A policy-based intervention for the reduction of communication breakdowns in inpatient surgical care: results from a Harvard surgical safety collaborative.

July 13, 2011

Deployment of rapid response teams by 31 hospitals in a statewide collaborative.

April 15, 2015

Effects of healthcare organization actions and policies related to COVID-19 on perceived organizational support among U.S. internists: a national study.

June 1, 2022

Pilot testing of a model for insurer-driven, large-scale multicenter simulation training for operating room teams.

December 11, 2013

2020 Pennsylvania Patient Safety Reporting: an analysis of serious events and incidents from the nation’s largest event reporting database.

May 19, 2021

Patient safety trends in 2021: an analysis of 288,882 serious events and incidents from the nation’s largest event reporting database.

July 6, 2022

Patient safety trends in 2022: an analysis of 256,679 serious events and incidents from the nation’s largest event reporting database.

May 17, 2023

Sustaining innovations in complex health care environments: a multiple-case study of rapid response teams.

April 15, 2020

Surgical complications: disclosing adverse events and medical errors.

January 16, 2013

Use of recalled devices in new device authorizations under the US Food and Drug Administration's 510(k) pathway and risk of subsequent recalls.

January 25, 2023

Nurses' perceptions of how rapid response teams affect the nurse, team, and system.

March 9, 2011

Long-term care healthcare-associated infections in 2021: an analysis of 17,971 reports.

July 13, 2022

Long-term care healthcare-associated infections in 2022: an analysis of 20,216 reports.

May 24, 2023

An integrative review: fatigue among nurses in acute care settings.

November 5, 2014

Computerized physician order entry of medications and clinical decision support can improve problem list documentation compliance.

July 30, 2008

Mortality due to hospital-acquired infection after cardiac surgery.

June 1, 2022

Patient safety culture: the impact on workplace violence and health worker burnout.

February 8, 2023

How does workplace violence-reporting culture affect workplace violence, nurse burnout, and patient safety?

December 7, 2022

Patient safety concerns in COVID-19–related events: a study of 343 event reports from 71 hospitals in Pennsylvania.

July 8, 2020

Radiology errors: are we learning from our mistakes?

October 7, 2009

Automatic detection of omissions in medication lists.

August 24, 2011

Analysis of readmissions in a mobile integrated health transitional care program using root cause analysis and common cause analysis.

May 25, 2022

National surveillance of emergency department visits for outpatient adverse drug events in children and adolescents.

March 5, 2008

Impacts of operational failures on primary care physicians' work: a critical interpretive synthesis of the literature.

May 13, 2020

Deafening silence? Time to reconsider whether organisations are silent or deaf when things go wrong.

August 6, 2014

Improving anesthesiologists' ability to speak up in the operating room: a randomized controlled experiment of a simulation-based intervention and a qualitative analysis of hurdles and enablers.

January 13, 2016

For children admitted to hospital, what interventions improve medication safety on ward rounds?

March 1, 2023

Giving voice to quality and safety matters at board level: a qualitative study of the experiences of executive nurses working in England and Wales.

August 24, 2016

Patient characteristics and the occurrence of never events.

February 24, 2010

Association of face-to-face handoffs and outcomes of hospitalized internal medicine patients.

April 29, 2015

Missed opportunities for diagnosis: lessons learned from diagnostic errors in primary care.

January 13, 2016

Identifying and reducing medication errors in psychiatry: creating a culture of safety through the use of an adverse event reporting mechanism.

April 6, 2011

The simulated ward: ideal for training clinical clerks in an era of patient safety.

May 9, 2012

Effects of a multimodal transitional care intervention in patients at high risk of readmission: the TARGET-READ randomized clinical trial.

May 17, 2023

Medication reconciliation in a community pharmacy setting.

August 11, 2010

Patient safety in dermatology: a review of the literature.

February 17, 2010

Overdiagnosis in low-dose computed tomography screening for lung cancer.

December 18, 2013

The SAGES Fundamental Use of Surgical Energy program (FUSE): history, development, and purpose.

February 14, 2018

Association of primary care clinic appointment time with opioid prescribing.

September 11, 2019

Improving medication management for patients: the effect of a pharmacist on post-admission ward rounds.

June 29, 2005

Creating a better discharge summary: improvement in quality and timeliness using an electronic discharge summary.

May 6, 2009

Medication error in the care of HIV/AIDS patients: electronic surveillance, confirmation, and adverse events.

September 7, 2005

Interventions promoting employee "speaking-up" within healthcare workplaces: a systematic narrative review of the international literature.

June 2, 2021

Bridging the communication gap in the operating room with medical team training.

November 2, 2005

From physician intent to the pharmacy label: prevalence and description of discrepancies from a cross-sectional evaluation of electronic prescriptions.

February 26, 2014

Opioid prescribing patterns and complications in the dermatology Medicare population.

March 7, 2018

Adverse inpatient outcomes during the transition to a new electronic health record system: observational study.

August 10, 2016

The emergency department trigger tool: a novel approach to screening for quality and safety events.

September 30, 2020

Adverse events present on arrival to the emergency department: the ED as a dual safety net.

March 11, 2020

Near-miss events detected using the emergency department trigger tool.

March 15, 2023

Emergency department adverse events detected using the emergency department trigger tool.

August 24, 2022

Staffing, teamwork and scope of practice: analysis of the association with patient safety in the context of rehabilitation.

December 15, 2021

Safety of surgical telehealth in the outpatient and inpatient setting.

January 13, 2021

Global oncology pharmacy response to COVID-19 pandemic: medication access and safety.

June 10, 2020

Nonhospital health care–associated hepatitis B and C virus transmission: United States, 1998-2008.

February 18, 2009

Severe staffing and personal protective equipment shortages faced by nursing homes during the COVID-19 pandemic.

September 16, 2020

Patient mortality during unannounced accreditation surveys at US hospitals.

April 5, 2017

Opioid-prescribing patterns of emergency physicians and risk of long-term use.

March 1, 2017

Patterns of potential opioid misuse and subsequent adverse outcomes in Medicare, 2008 to 2012.

June 6, 2018

Evidence-based medicine: a cornerstone for clinical care but not for quality improvement.

May 15, 2019

Coupling policymaking with evaluation—the case of the opioid crisis.

December 20, 2017

Reducing falls and fall-related injuries in mental health: a 1-year multihospital falls collaborative.

November 13, 2013

Effects of weekend admission and hospital teaching status on in-hospital mortality.

March 6, 2005

Comparative accuracy of diagnosis by collective intelligence of multiple physicians vs individual physicians.

March 13, 2019

Postsurgical prescriptions for opioid naive patients and association with overdose and misuse: retrospective cohort study.

January 31, 2018

Why it is so hard to talk about overuse in pediatrics and why it matters.

August 30, 2017

Patient misidentification in Papanicolaou tests: a systems-based approach to reducing errors.

August 19, 2009

Implementing a pediatric surgical safety checklist in the OR and beyond.

July 14, 2010

An overview of intravenous-related medication administration errors as reported to MEDMARX(R), a national medication error-reporting program.

February 8, 2006

Near miss research in the healthcare system: a scoping review.

May 25, 2022

Effect of a central call center on employee perceptions of safety culture within community pharmacies in an academic health system.

June 5, 2019

Adverse events and emergency department opioid prescriptions in adolescents.

June 30, 2021

Medication governance: preventing errors and promoting patient safety.

March 15, 2017

Flaws in clinical reasoning: a common cause of diagnostic error.

January 11, 2012

Strategies to increase reporting of near misses and adverse events.

March 28, 2007

Chemotherapy regimen checks performed by pharmacists contribute to safe administration of chemotherapy.

December 2, 2015

Communication failure in the operating room.

November 3, 2010

Positive deviance: a new tool for infection prevention and patient safety.

October 16, 2013

High risk prescribing in primary care patients particularly vulnerable to adverse drug events: cross sectional population database analysis in Scottish general practice.

July 6, 2011

Surgical team training: the Northwestern Memorial Hospital experience.

February 25, 2009

Insurance claims for wrong-side, wrong-organ, wrong-procedure, or wrong-person surgical errors: a retrospective study for 10 years.

February 8, 2023

Common and consequential fractures that should not be missed in children.

November 30, 2022

Evidence of respiratory infection transmission within physician offices could inform outpatient infection control.

September 1, 2021

Reported clinical incidents of children with intellectual disability: a qualitative analysis.

June 15, 2022

View More

Related Resources

How do we learn about error? A cross-sectional study of urology trainees.

June 28, 2023

Bad things can happen: are medical students aware of patient centered care and safety?

January 25, 2023

How do hospital inpatients conceptualise patient safety? A qualitative interview study using constructivist grounded theory.

October 19, 2022

Video-based communication assessment of physician error disclosure skills by crowdsourced laypeople and patient advocates who experienced medical harm: reliability assessment with generalizability theory.

May 18, 2022

Simulation-based assessment identifies longitudinal changes in cognitive skills in an anesthesiology residency training program.

September 22, 2021

The implementation of communication didactics for OB/GYN residents on the disclosure of adverse perioperative events.

July 7, 2021

Developing open disclosure strategies to medical error using simulation in final-year medical students: linking mindset and experiential learning to lifelong reflective practice.

March 31, 2021

"Good catch, Kiddo"--enhancing patient safety in the pediatric emergency department through simulation.

December 9, 2020

Influence of socioeconomic bias on emergency medicine resident decision making and patient care.

August 19, 2020

Prevalence, types, and sources of bullying reported by US general surgery residents in 2019.

June 17, 2020

What constitutes effective team communication after an error?

May 27, 2020

Impact of critical event checklists on anaesthetist performance in simulated operating theatre emergencies.

July 31, 2019

Interventions to reduce burnout and improve resilience: impact on a health system's outcomes.

June 12, 2019

Knowledge retention after simulated crisis: importance of independent practice and simulated mortality.

June 5, 2019

Understanding the clinical implications of resident involvement in uncommon operations.

May 1, 2019

Failure to debrief after critical events in anesthesia is associated with failures in communication during the event.

March 20, 2019

Utilizing a Systems and Design Thinking Approach for Improving Well-Being Within Health Professional Education and Health Care.

January 16, 2019

"To err is human" but disclosure must be taught: a simulation-based assessment study.

February 28, 2018

Effect of sleep deprivation after a night shift duty on simulated crisis management by residents in anaesthesia. A randomised crossover study.

October 18, 2017

Readiness of US general surgery residents for independent practice.

October 4, 2017

Comparison of appendectomy outcomes between senior general surgeons and general surgery residents.

May 3, 2017

You can't blame the wreck on the train.

February 8, 2017

Operative team communication during simulated emergencies: too busy to respond?

December 21, 2016

The effects of power, leadership and psychological safety on resident event reporting.

June 1, 2016

Simulation techniques for teaching time-outs: a controlled trial.

June 1, 2016

How surgical trainees handle catastrophic errors: a qualitative study.

July 1, 2015

A model of disruptive surgeon behavior in the perioperative environment.

October 15, 2014

Disclosure of adverse events and errors in surgical care: challenges and strategies for improvement.

June 4, 2014

Rapid learning of adverse medical event disclosure and apology.

April 9, 2014

Teaching medical error disclosure to residents using patient-centered simulation training.

January 8, 2014

View More

See More About The Topic

Health Care Providers

Organizational Behaviorists

General Surgery

To sign up for updates or to access your subscriber preferences, please enter your email address below.

5600 Fishers Lane
Rockville, MD 20857
Telephone: (301) 427-1364