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At least 73 records · Page 4Linked to original sources
PubMed2004

Identifying and reducing errors with surgical simulation.

The major determinant of a patient's safety and outcome is the skill and judgment of the surgeon. While knowledge base and decision processing are evaluated during residency, technical skills-which are at the core of the profession-are not evaluated. Innovative state of the art simulation devices that train both surgical tasks and skills, without risk to patients, should allow for the detection and analysis of errors and "near misses". Studies have validated the use of a sophisticated endoscopic sinus surgery simulator (ES3) for training residents on a procedural basis. Assessments are proceeding as to whether the integration of a comprehensive ES3 training programme into the residency curriculum will have long term effects on surgical performance and patient outcomes. Using various otolaryngology residencies, subjects are exposed to mentored training on the ES3 as well as to minimally invasive trainers such as the MIST-VR. Technical errors are identified and quantified on the simulator and intraoperatively. Through a web based database, individual performance can be compared against a national standard. An upgraded version of the ES3 will be developed which will support patient specific anatomical models. This advance will allow study of the effects of simulated rehearsal of patient specific procedures (mission rehearsal) on patient outcomes and surgical errors during the actual procedure. The information gained from these studies will help usher in the next generation of surgical simulators that are anticipated to have significant impact on patient safety.

Computer-Assisted Instruction↗
PubMed1997

[Surgical injuries registered in the Norwegian system for patient injuries. Possibilities of the use of the material for quality improvement in Norwegian hospitals].

328 surgical "errors" reported to the Norwegian System of Compensation for Injuries to Patients were analysed in order to find out how the errors can be exploited for the purpose of quality improvement. In 8% of the cases the patients had been treated as emergency cases. 7% of the patients had been treated as out-patients. 30% of the patients had become more than 15% permanently disabled as a consequence of the "error". The Norwegian System of Compensation for Injuries to Patients operates with five different categories of errors defined by medical specialty, of which surgery is one. We found that among "surgical errors" 16% of the patients had been treated by an anaesthetist or by a specialist in internal medicine, and 13% had been treated by a gynaecologist. There were several recurring "errors" such as nerve injuries and complications related to general atherosclerosis. A system for categorising errors with a view to quality improvement should be different from other systems of categorisation. We suggest a system based on not only five but all medical specialties. Data from such a system could be used to prepare "pedagogic reports" that can be sent to the managers of services and education in each medical specialty. Thus, by turning surgical errors into "medical treasures", the errors can be exploited to promote quality improvement.

Clinical Competence↗
PubMed1997

Effect of training and experience on cephalometric measurement errors on surgical patients.

The aim of this study was to quantify and compare the cephalometric measurement errors (interexaminer errors) between two orthodontic residents and two oral and maxillofacial surgical residents with differing years of experience. It was hypothesized that the measurement errors would differ between observers with different training backgrounds and experience and that this would lead to significant disagreements in the cephalometric assessment of patients to receive combined orthodontic and orthognathic surgical treatment. Thirty cephalograms were used in the evaluation. Each examiner independently digitized all cephalograms twice. Common cephalometric skeletal and dental variables, 18 angular and 9 linear, were measured. Interexaminer errors were calculated using two-sample t tests for every pair of examiners. The interexaminer error was large in both landmark identification and in angular and linear measurements. The amount of error did not depend on training or experience but probably on individual conception of landmark definition and perception of landmark location. Methods to limit interexaminer measurement errors are described.

Adult↗
PubMed2006

Errors and error rates in surgical pathology: an Association of Directors of Anatomic and Surgical Pathology survey.

This survey on errors in surgical pathology was commissioned by the Association of Directors of Anatomic and Surgical Pathology Council to explore broad perceptions and definitions of error in surgical pathology among its membership and to get some estimate of the perceived frequency of such errors. Overall, 41 laboratories were surveyed, with 34 responding to a confidential questionnaire. Six small, 13 medium, and 10 large laboratories (based on specimen volume), predominantly located in the United States, were surveyed (the remaining 5 laboratories did not provide this particular information). The survey questions, responses, and associated comments are presented. It is clear from this survey that we lack uniformity and consistency with respect to terminology, definitions, and the identification/documentation of errors in surgical pathology. An appeal is made for the urgent need to reach some consensus in order to address these discrepancies as we prepare to combat the issue of errors in surgical pathology.

Data Collection↗
PubMedDate not supplied

Errors by surgical pathologists in India: results of a questionnaire survey.

BACKGROUND: Data from the United Kingdom show that most surgical pathologists are aware of about one serious mistake in their reports every year. There are no corresponding data from India or the developing world. I made an attempt to determine the rate of error made by Indian pathologists. METHODS: A postal questionnaire was sent to 96 pathologists and 71 clinicians in different cities. The questions included some related to their experience with error in histopathology, as well as a few on the respondents' views on the legal and ethical aspects in the case of medical error. RESULTS: Fifty pathologists and 47 clinicians responded. Of the evaluable responses, 32 pathologists were aware of 86 errors in the past 5 years, while 30 clinicians recalled 162 errors. Most mistakes that pathologists remembered were cases related to lymphoid disease (n = 15) while for clinicians, gastrointestinal tract (n = 12) and lymphoid tissue (n = 9) were common sites of error. Benign-malignant errors were the most common type of error. CONCLUSION: The discrepancy between the rates of error between the two groups suggests that better pathologist-clinician communication is required. Medical councils and related governing bodies should consider introducing a quality control programme for anatomic pathology.

Clinical Medicine↗
PubMed2004

[Typical and avoidable doctor's errors in surgical gastroenterology].

Everyone makes mistakes, and even the greatest efforts may fail to eliminate them completely. In contrast, typical errors and miscalculations--which by the very fact of being typical are predictable--can and must be avoided. The reasons for such mistakes may be lack of experience, inadequate interdisciplinary cooperation, and ignorance of the current state of the art. This applies equally, and in particular, to the field of surgical gastroenterology. Intensive interdisciplinary discussions, a healthy surgical hierarchy, a knowledge of pertinent guidelines and the latest literature and, last, but not least--against the present background of discussions about working hour and diagnosis-related groups--a rested and motivated physician, are the pillars of error-free patient management.

Acute Disease↗
PubMed2004

Error in surgical pathology.

A total of 272 surgical pathology claims reported to The Doctors Company from 1998 through 2003 were reviewed. They were analyzed and repetitive patterns involving both specimen type and category of diagnostic error were identified. These patterns were then compared with those uncovered in a prior review of 218 surgical pathology claims reported from 1995 through 1997 to identify trends and see if new patterns of diagnostic error had emerged.

Diagnostic Errors↗
PubMed2007

Measuring errors in surgical pathology in real-life practice: defining what does and does not matter.

This review summarizes our experience using blinded review as a method to measure quality in surgical pathology. It details the specifics about how the review is performed, the weaknesses in the method, and then summarizes our results so far. These results suggest that error rates correlate with the individual pathologist, the type of specimen, the type of diagnosis, subspecialization, and the number of pathologists who review a case. Errors do not correlate with workload. This method is relatively unbiased and effective at identifying significant errors in real life clinical practice. The drawback to this method is the amount of work involved. Blinded review, performed so that errors can be corrected in a timely manner, and eventually integrated into an interlaboratory review process, represents a realistic and fair method to provide quantitative quality assurance information.

Bias↗
PubMed1997

[Errors in surgical techniques: a cause of complications in tympanoplasty. Part I].

The analysis of follow-ups shows, that the lack of success in tympanoplasty is often due to errors in operative technique and insufficient postoperative analysis of our failures. The failures has to be analysed in any case, always with exactly operative report comprises the dynamics factors of the operation and written immediately after surgery.

Humans↗