Medical errors, incidents, accidents and violations.
Atul Gawande: <I>'The real problem isn't how to stop bad doctors from harming, even killing their patients. It's how to prevent good doctors from doing so.'</I>A. Gawande: When doctors make mistakes. The New Yorker, 1st February 1999; 40-55.Errors are an integral part of human behaviour and performance, and in this respect, medical/ surgical practice is no exception. Undoubtedly medical errors account for substantial patient morbidity and mortality. The subject is complicated due to complex and at times confusing taxonomy and the lack of agreed definitions and classification of medical/ surgical errors. It is not possible to eliminate errors from clinical practice but we can improve the quality of medical care by adopting error-tolerant operating medical systems (E-TOMS) based on progress in cognitive psychology, human factors, and human reliability assessment made during the past 30 years. E-TOMS should enable detection, reporting and targeted reduction of errors, and together with effective team dynamics, good clinical governance incorporating root-cause analysis of adverse events during the delivery of health care should improve the quality of care that we can provide for our patients.
Cuschieri
Department of Surgery and Molecular Oncology and Surgical Skills Unit University of Dundee Scotland.