Narrow Results Clear All
- Communication Improvement 22
- Culture of Safety 7
Education and Training
- Students 1
- Error Reporting and Analysis
- Human Factors Engineering 3
- Legal and Policy Approaches 31
- Policies and Operations 3
- Quality Improvement Strategies 8
- Specialization of Care 2
- Technologic Approaches 2
- Transparency and Accountability 8
- Device-related Complications 3
- Diagnostic Errors 7
- Discontinuities, Gaps, and Hand-Off Problems 2
- Failure to rescue 1
- Identification Errors 2
- Medical Complications 4
- Medication Safety 5
- Nonsurgical Procedural Complications 3
- Psychological and Social Complications 6
- Second victims 1
- Surgical Complications 9
- Internal Medicine 14
- Nursing 1
- Pharmacy 1
- Family Members and Caregivers 7
- Health Care Executives and Administrators 33
Health Care Providers
- Physicians 28
- Non-Health Care Professionals 18
- Patients 43
Search results for "North America"
Rein L. Washington Post. August 30, 2019.
Palmer J. Patient Saf Qual Healthc. May/June 2019.
Organizations must learn from adverse events to prevent similar incidents. Reporting on lessons to be learned from the cascade of failures connected with the preventable death of a patient during an acute asthma attack at the door of a hospital emergency department, this magazine article outlines the importance of effective signage, appropriate security staff placement, and acceptance of the responsibility for failure.
Park A. Time Magazine. January 24, 2019.
This news article reports on the documentary To Err Is Human, which was produced and directed by the son of patient safety leader Dr. John M. Eisenberg. The film is structured around patient safety advocate Sue Sheridan's experience with diagnostic errors that resulted in harm for both her son and husband. It features a wide range of experts who discuss the impact of error on all involved, the role of culture in facilitating both mistakes and progress, and why continued work in health care safety is needed.
Beck DL. ASH Clinical News. December 1, 2018.
McGrory K, Bedi N. Tampa Bay Times. November 28, 2018.
Peskin SM. New York Times. October 4, 2018.
Error disclosures are difficult but important conversations that can have negative consequences for patients, clinicians, and organizations, even when they are done appropriately. This newspaper article offers insights from a doctor who experienced both sides of disclosure, as a physician disclosing an error and as a patient whose physician missed a complication, and discusses how to manage relationships once clinical mistakes are recognized.
Boodman SG. Kaiser Health News. March 15, 2017.
This news article reports on two incidents involving medical errors—one demonstrating the traditional shroud of secrecy and the other building on transparency and open disclosure—to illustrate the value of honest apology, discussion, and resolution of medical error for clinicians, patients, and families.
Sweeney JF. Med Econ. November 10, 2016.
Disclosure and candor with patients after a medical error has gained support from organizations, clinicians, and patients. This magazine article discusses how initiatives such as communication-and-resolution programs can reduce lawsuits, provide opportunities for learning, and improve physician–patient relationships.
Tozzi J. Bloomberg News Service. June 10, 2016.
Miller N. The Pathologist. June 2016(20):18-29; July 2016(21):18-33.
In light of the growing focus on diagnostic errors, this magazine series reports on unique challenges that pathologists face when they discover potential errors. The first article in the series discusses how pathologists may experience barriers to disclosure including feeling shame in disclosing their own error, discomfort with raising concerns about a colleague who has misdiagnosed a patient, and lack of direct relationships with patients. The second article expands the discussion to focus on how industry support of open transparency can enable pathologists to participate in reporting and disclosure activities.
Abelson J, Staltzman J. Boston Globe. April 13, 2016.
Although scheduling overlapping surgeries may improve operating room efficiency, the practice can diminish patient safety. This newspaper article reports on new standards issued by the American College of Surgeons to reduce risks associated with concurrent surgeries, reviews a previous news investigation into the practice, and includes reactions from clinicians.
Cohen E. CNN. March 24, 2016.
Poor communication regarding medical errors can contribute to patient and family frustration and fear. Reporting on a case involving disclosure of a wrong-site surgery, this news article describes a resolution program to help patients cope after a preventable error. The program includes apology, disclosure, and explanation of what occurred as well as financial compensation.
Landro L. Wall Street Journal. February 1, 2016.
Communication and resolution strategies that emphasize early disclosure after a medical error can enhance patient safety. This newspaper article reports on communication and resolution programs, how they can provide support for patients, elements that contribute to their success, and efforts to guide hospitals in developing such programs.
Rice S. Modern Healthc. August 15, 2015.
Wachter R, Kaplan GS, Gandhi T, Leape L. Health Affairs Blog. June 22, 2015.
Transparency is recognized as a key element of safe, patient-centered care. This article offers insights from patient safety experts on how transparency can augment patient safety, barriers such as discomfort with disclosure and fears about negative consequences, and steps leaders can take to achieve greater transparency in their organizations.
Hertz BT. Med Econ. 2015;92:40-44.
Communication and response strategies have been shown to improve how organizations, clinicians, and patients and their families recover from adverse incidents. This news article discusses apology laws which protect certain statements regarding disclosure from being admissible in court and highlights how sensitivity to patients and transparent communication about the failure can be beneficial for both clinicians and patients after a medical error.
Gubar S. New York Times. October 30, 2014.
This newspaper article describes how surgical complications, health care–associated infections, and ineffective patient–provider communication contributed to a patient's experience with harm and suggests that transparency around the incident and preoperative patient briefings could have improved the situation.
Connor M, Wayman KI, Garcia C, Fischer PR; Consortium for Maximizing Family-Centered Care. Patient Saf Qual Healthc. September/October 2014;11:36,38-40,42.
Patients are increasingly encouraged to take an active role in their own safety during hospital care. Describing a near miss of a medication error, this magazine article examines elements of effective disclosure and how engaging patients and their families can contribute to error investigations and safety improvement.
Kowalczyk L. Boston Globe. August 31, 2014.
Reporting on an incident involving administration of an inappropriate dye which led to a patient's death, this newspaper article reveals how cognitive biases may have played a role and steps the hospital took to prevent similar errors. Six Massachusetts hospitals have launched a pilot program for early apology and resolution in an effort to enhance patient satisfaction and safety.
Agency for Healthcare Research and Quality. Health Care Innovations Exchange. June 18, 2014.
Full disclosure programs have shown to be effective mechanisms for early resolution of adverse events. This article reveals one early adopter's experience with full disclosure and provides insights from the architects of the program to guide others in implementing similar strategies and spread success associated with the approach.