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Small Changes, Stark Differences: Errors in Otolaryngology

by Andrea M. Sattinger •

Standardization can also be a boon to preventing errors, and yet does not have to take away from a clinician’s autonomy.9 Indeed, we would argue, the opposite is true, said Dr. Shah. It frees you up to practice the art of medicine. Standardizing forms or protocols allows the practitioner to focus on making the diagnosis and developing a relationship with the patient. He admits that he had to sell himself on this concept. Five years ago I thought that standardized tonsillectomy and adenoidectomy postoperative forms were ridiculous. … But now I ask, why am I spending the extra five minutes to write individual orders for each patient when a standard form that results in fewer errors takes me a minute to fill out? Then I can spend the extra four minutes talking to the patient or teaching the residents. It’s a mind shift, he said, that can help any otolaryngologist improve quality and safety.

My residents are getting trained with a different culture; and not just mine, this is a nationwide experience with patient safety and quality being inculcated into residency training. So hopefully 15 to 20 years down the road, the same surgeons will be training their residents with the culture of safety.

Preventing Errors: Easy Fixes Make a Difference

  • Notice the details of what you and your colleagues and staff members are doing.
  • Use and advocate for surgical time-outs.
  • Follow good medication practices: medication reconciliation, read backs on verbal orders, limit abbreviations, keep look-alike and sound-alike medications in separate locations; make careful choices regarding drug labeling, packaging, and storage.
  • Practice leadership from the top down.
  • Look for ways to make small changes that can have large ramifications.
  • Don’t resist standardization; it can support your autonomy.

Where Are Errors Made in Otolaryngology?

Errors in otolaryngology were classified as related to:

  • History and physical = 1.4%
  • Differential or final diagnosis = 1.4%
  • Testing = 10.4%
  • Surgical planning = 9.9%
  • Wrong-site surgery = 6.1%
  • Anesthesia = 3.3%
  • Wrong drug/dilution on the surgical field = 3.8%
  • Technical = 19.3%
  • Retained foreign body = 0.9%
  • Equipment = 9.4%
  • Postoperative care = 8.5%
  • Medical management = 13.7%
  • Nursing/ancillary = 0.5%
  • Administrative = 6.6%
  • Communication = 3.8%
  • Miscellaneous = 0.9%

Source: Shah RK et al. Laryngoscope 2004;114:1322-35.

References

  1. Kohn LT, Corrigan JM, Donaldson MS, Institute of Medicine Committee on Quality of Health Care in America. To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press; 1999.
    [Context Link]
  2. Stelfox HT, Palmisani S, Scurlock C, Orav EJ, Bates DW. The To Err is Human report and the patient safety literature. Qual Saf Health Care 2006;15:174-178.
    [Context Link]
  3. Hagland M. Safety when it counts. Patient safety moves forward in some hospitals but, seven years after the Quality chasm report, progress is still spotty. Healthc Inform 2006;23:30, 32-4.
    [Context Link]
  4. Longo DR, Hewett JE, Ge B, Schubert S. The long road to patient safety: a status report on patient safety systems. JAMA 2005;294:2858-65.
    [Context Link]
  5. Bates DW, Gawande AA. Error in medicine: what have we learned? Ann Intern Med 2000;132:763-767.
    [Context Link]
  6. Berwick DM. A user’s manual for the IOM’s Quality Chasm report. Health Aff 2002;21:80-90.
    [Context Link]
  7. IOM report recommends comprehensive strategies to reduce medication errors. Hosp Health Netw 2006;80:69-70.
    [Context Link]
  8. Lubell J, DoBias M. Medication errors persist: IOM. Report highlights steps to reduce severity, frequency. Mod Healthc 2006;36:10.
    [Context Link]
  9. Roberson DW, Kentala E, Healy GB. Quality and safety in a complex world: why systems science matters to otolaryngologists. Laryngoscope 2004;114:1810-4.
    [Context Link]
  10. Shah RK, Kentala E, Healy GB, Roberson DW. Classification and consequences of errors in otolaryngology. Laryngoscope 2004;114:1322-35.
    [Context Link]
  11. Shah RK, Roberson DW, Healy GB. Errors and adverse events in otolaryngology. Curr Opin Otolaryngol Head Neck Surg 2006;14:164-169.
    [Context Link]
  12. Elder NC, Dovey SM. Classification of medical errors and preventable adverse events in primary care: a synthesis of the literature. J Fam Pract 2002;51:927-32.
    [Context Link]
  13. Dovey SM, Meyers DS, Phillips RL Jr. et al. A preliminary taxonomy of medical errors in family practice. Qual Saf Health Care 2002;11:233-8.
    [Context Link]
  14. Leape LL. Errors are not diseases: they are symptoms of diseases. Laryngoscope 2004;114:1320-1.
    [Context Link]
  15. Gawande AA, Zinner MJ, Studdert DM, Brennan TA. Analysis of errors reported by surgeons at three teaching hospitals. Surgery 2003;133:614-21.
    [Context Link]
  16. Rogers SO, Jr., Gawande AA, Kwaan M et al. Analysis of surgical errors in closed malpractice claims at 4 liability insurers. Surgery 2006;140:25-33.
    [Context Link]

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