Medical error in dermatology practice: development of a classification system to drive priority setting in patient safety efforts.
BACKGROUND
To date, no study to our knowledge has examined the nature and scope of medical error in dermatology practice.


OBJECTIVE
We sought to collect and categorize physician-reported errors in dermatology practice.


METHODS
A survey regarding most recent and most serious errors was developed and distributed to dermatologists attending US meetings. A total of 150 responses were received outlining 152 most recent errors and 130 most serious errors. Survey responses, along with classification systems for other specialties, were used to develop a classification system for medical error in dermatology.


RESULTS
The respondents' demographics reflected the specialty: 63% were male, 60% were older than 50 years, and 60% were in solo or group private practice. Of the most recent errors reported, 85% happened once a year or less, and 86% did not result in harm to patients. The most common categories of both most recent and most serious errors were related to assessment (41% and 31%, respectively) and interventions (44% and 52%, respectively). Assessment errors were primarily related to investigations, and commonly involved the biopsy pathway. Intervention errors in the most recent and most serious errors were split between those related to medication (54% and 27%) and those related to procedures (46% and 73%). Of note, 5 and 21 wrong-site surgeries were reported in the most recent and most serious errors groups, respectively.


CONCLUSIONS
Our findings are subject to respondent and recall bias and our classification system, although an important first step, is likely incomplete.


CONCLUSIONS
Our findings highlight several key areas of patient care in need of safety initiatives, namely the biopsy pathway, medication management, and prevention of wrong-site surgery.
Department of Dermatology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA. AJWatson@partners.org
Alice J
AJ
Watson
Kelley
K
Redbord
James S
JS
Taylor
Alison
A
Shippy
James
J
Kostecki
Robert
R
Swerlick
D000328:Adult; D001706:Biopsy / Q000592:standards / Q000706:statistics & numerical data; D003880:Dermatology / Q000592:standards* / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000145:classification* / Q000706:statistics & numerical data*; D008508:Medication Errors / Q000145:classification / Q000706:statistics & numerical data; D008875:Middle Aged; D061214:Patient Safety; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care