Tags

Type your tag names separated by a space and hit enter

Medical errors involving trainees: a study of closed malpractice claims from 5 insurers.
Arch Intern Med. 2007 Oct 22; 167(19):2030-6.AI

Abstract

BACKGROUND

Despite wide recognition that the delivery of medical care by trainees involves special risks, information about the types and causes of medical errors involving trainees is limited. To describe the characteristics of and factors contributing to trainee errors, we analyzed malpractice claims in which trainees were judged to have played an important role in harmful errors.

METHODS

The claims were closed between 1984 and 2004, and the errors occurred between 1979 and 2001. Specialist physicians reviewed random samples of closed malpractice claim files at 5 liability insurers from 2002 to 2004 and determined whether injuries had occurred, and if so, whether they were due to error. We described the clinical circumstances and contributing factors associated with harmful errors involving trainees ("cases"). We also compared the characteristics of cases with their nontrainee counterparts and probed trainee errors attributed to teamwork problems and lack of technical competence or knowledge.

RESULTS

Among 240 cases, errors in judgment (173 of 240 [72%]), teamwork breakdowns (167 of 240 [70%]), and lack of technical competence (139 of 240 [58%]) were the most prevalent contributing factors. Lack of supervision and handoff problems were most prevalent types of teamwork problems, and both were disproportionately more common among errors that involved trainees than those that did not (respectively, 54% vs 7% [P < .001] and 20% vs 12% [P = .009]). The most common task during which failures of technical competence occurred were diagnostic decision making and monitoring of the patient or situation. Trainee errors appeared more complex than nontrainee errors (mean of 3.8 contributing factors vs 2.5 [P < .001]).

CONCLUSIONS

In addition to problems with handoffs, house staff are particularly vulnerable to medical errors owing to teamwork failures, especially lack of supervision. Graduate medical education reform should focus on strengthening these aspects of training.

Authors+Show Affiliations

Health Policy and Quality Program, Houston Center for Quality of Care and Utilization Studies, Houston, Texas, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17954795

Citation

Singh, Hardeep, et al. "Medical Errors Involving Trainees: a Study of Closed Malpractice Claims From 5 Insurers." Archives of Internal Medicine, vol. 167, no. 19, 2007, pp. 2030-6.
Singh H, Thomas EJ, Petersen LA, et al. Medical errors involving trainees: a study of closed malpractice claims from 5 insurers. Arch Intern Med. 2007;167(19):2030-6.
Singh, H., Thomas, E. J., Petersen, L. A., & Studdert, D. M. (2007). Medical errors involving trainees: a study of closed malpractice claims from 5 insurers. Archives of Internal Medicine, 167(19), 2030-6.
Singh H, et al. Medical Errors Involving Trainees: a Study of Closed Malpractice Claims From 5 Insurers. Arch Intern Med. 2007 Oct 22;167(19):2030-6. PubMed PMID: 17954795.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Medical errors involving trainees: a study of closed malpractice claims from 5 insurers. AU - Singh,Hardeep, AU - Thomas,Eric J, AU - Petersen,Laura A, AU - Studdert,David M, PY - 2007/10/24/pubmed PY - 2007/12/6/medline PY - 2007/10/24/entrez SP - 2030 EP - 6 JF - Archives of internal medicine JO - Arch Intern Med VL - 167 IS - 19 N2 - BACKGROUND: Despite wide recognition that the delivery of medical care by trainees involves special risks, information about the types and causes of medical errors involving trainees is limited. To describe the characteristics of and factors contributing to trainee errors, we analyzed malpractice claims in which trainees were judged to have played an important role in harmful errors. METHODS: The claims were closed between 1984 and 2004, and the errors occurred between 1979 and 2001. Specialist physicians reviewed random samples of closed malpractice claim files at 5 liability insurers from 2002 to 2004 and determined whether injuries had occurred, and if so, whether they were due to error. We described the clinical circumstances and contributing factors associated with harmful errors involving trainees ("cases"). We also compared the characteristics of cases with their nontrainee counterparts and probed trainee errors attributed to teamwork problems and lack of technical competence or knowledge. RESULTS: Among 240 cases, errors in judgment (173 of 240 [72%]), teamwork breakdowns (167 of 240 [70%]), and lack of technical competence (139 of 240 [58%]) were the most prevalent contributing factors. Lack of supervision and handoff problems were most prevalent types of teamwork problems, and both were disproportionately more common among errors that involved trainees than those that did not (respectively, 54% vs 7% [P < .001] and 20% vs 12% [P = .009]). The most common task during which failures of technical competence occurred were diagnostic decision making and monitoring of the patient or situation. Trainee errors appeared more complex than nontrainee errors (mean of 3.8 contributing factors vs 2.5 [P < .001]). CONCLUSIONS: In addition to problems with handoffs, house staff are particularly vulnerable to medical errors owing to teamwork failures, especially lack of supervision. Graduate medical education reform should focus on strengthening these aspects of training. SN - 0003-9926 UR - https://www.unboundmedicine.com/medline/citation/17954795/Medical_errors_involving_trainees:_a_study_of_closed_malpractice_claims_from_5_insurers_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/archinte.167.19.2030 DB - PRIME DP - Unbound Medicine ER -