Family physicians' solutions to common medical errors - Graham Center One-Pager

Date: March 15, 2003

In two U.S. studies about medical errors in 2000 and 2001, family physicians offered their ideas on how to prevent, avoid, or remedy the five most often reported medical errors. Almost all reports (94 percent) included at least one idea on how to overcome the reported error. These ideas ranged from "do not make errors" (34 percent of all solutions offered to these five error types) to more thoughtfully proposed solutions relating to improved communication mechanisms (30 percent) and ways to provide care differently (26 percent). More education (7 percent) and more resources such as time (2 percent) were other prevention ideas.

Of 416 error reports made by U.S. family physicians in two medical error studies in 2000 and 2001, 151 (36 percent) were about the most commonly reported errors involving the processes of ordering medications, implementing laboratory investigations, filing forms and maintaining patient records, implementing medication orders, and responding to abnormal laboratory test results.

Although identifying medical errors is an important first step in making primary care safer for patients, the major challenge is in finding ways to avoid them. When asked for their ideas on how to overcome the most common medical errors they reported, family physicians offered 228 distinct solutions, categorized in the accompanying table.

In 2000 and 2001, before patient safety was widely discussed in primary care settings, one third of family physicians' solutions for overcoming medical error were not very helpful--doing the same thing, but better. The practicing environment may make it difficult for physicians to think in terms of systems or to imagine alternatives to their immediate realities. Surprisingly, only a small minority of the other, more practical solutions for overcoming medical errors in primary care required additional resources, and these resources were almost always time-related rather than monetary. Specific changes such as stopping the use of carbon copy prescription forms, doing urgent laboratory tests in the office, and using flagging systems to draw attention to information needing action were all practical suggestions for alleviating these common errors. Various double-checking systems also were favored. In searching for solutions to medical errors, asking those involved in providing care for their ideas may be a rewarding strategy.

Categories of Solutions to Common Medical Errors Proposed byFamily Physicians Ordering ImplementingIdea on prevention, medications laboratory ordersavoidance, or (54 reports, (27 reports,remedy 87 ideas *) 41 ideas *)No idea reported ([dagger]) 1.9% 14.8%Do not make mistakes Be more diligent 41.4% 12.2% Follow protocols 1.1% 4.9%Provide care differently Change established habits 12.6% 9.8% Use double-checking system 10.3% 31.7%Better communicationWith patients 5.7% NA Between providers 17.2% 26.8% More/better education 6.9% 12.2%More resources 3.4% 2.4% ImplementingIdea on prevention, Filing system medication ordersavoidance, or (25 reports, (24 reports,remedy 40 ideas *) 34 ideas *)No idea reported ([dagger]) NA 4.2%Do not make mistakes Be more diligent 42.5% 20.6% Follow protocols 2.5% 2.9%Provide care differently Change established habits 2.5% 5.9% Use double-checking system 12.5% 14.7%Better communicationWith patients NA 11.8% Between providers 37.5% 32.4% More/better education 2.5% 8.8%More resources NA NAIdea on prevention, Responding to Total (151avoidance, or abnormal laboratory reports, 228remedy results (21 reports, ideas *) 26 ideas *)No idea reported ([dagger])Do not make mistakes 14.3% 6% Be more diligent Follow protocols 26.9% 31.6%Provide care differently 3.8% 2.6% Change established habits Use double-checking system 19.2% 10.1%Better communication 11.5% 15.4%With patients Between providers 3.8% 4.4% More/better education 26.9% 25.9%More resources 3.8% 7% 3.8% 2.2%NA = not applicable.* -- Remainder of the table shows percentages of ideas.([dagger])--Percentage of reports with no idea offered onprevention, remedy, or avoidance.

Adapted from Graham Center One-Pager #18. Dovey SM, Phillips RL, Green LA, Fryer GE. Family physicians' solutions to common medical errors. January 2003. Available at: www.aafppolicy.org/x396.xml. From the Robert Graham Center: Policy Studies in Family Practice and Primary Care, 1350 Connecticut Ave., NW, Suite 950, Washington, DC 20036 (telephone: 202-986-5708; fax: 202-986-7034; e-mail: policy@aafp.org).

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