Gossip — good or bad — may lead you to truth
Confidential interviews, e-mail are essential
Adverse events among medical inpatients are more likely to be identified by confidential interviews done with front-line house officers during morning rounds and by e-mail than by routine hospital reporting procedures.
Saul Weingart, MD, and colleagues at Beth Israel Deaconess Medical Center in Boston asked house officers to identify iatrogenic injuries and problems during peer-conducted confidential interviews over a period of 12 weeks. The findings are published in a recent issue of the Journal of General Internal Medicine (2000; 15:470-477).
During the 12-week surveillance interval, house officers reported 100 adverse events (AEs), potential adverse events, or other problems with quality of care involving 79 patients. Ten other events also were reported by nonphysicians. In comparison, only 58 incidents involving 51 patients were documented in the hospital incident reporting system, the investigators found.
Inadequate evaluation of a patient, at 16.4% of reported cases, was the most frequent problem associated with process of care, while failure to monitor or follow a patient occurred in 12.7% of reported cases. Failure to do a laboratory test occurred in 12.7% of cases, and in 10.8% of cases the problem was associated with some type of medication error.
"Inviting house officers and other front-line clinicians to participate in abbreviated confidential interviews is a promising way to detect AEs and medical errors," the investigators conclude. They say house officers are "potentially valuable partners in quality improvement."
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