Abstract
Abstract
Background
Error management plays a key role in patient safety. It is a systematic approach aimed at identifying and learning from critical incidents by reporting, documenting and analyzing them. Almost nothing is known about the incidents physicians in outpatient care consider to be critical and how they deal with them. We carried out an interview study to explore outpatient physicians’ views on error management, discover what they regard as critical incidents, and find out how error management is put into practice in ambulatory care.
Methods
We conducted 72 semi-structured interviews with physicians from ambulatory practices. We asked participants what they considered to be a critical incident, how they reacted following an incident, how they discussed incidents with their coworkers, and whether they used critical incident reporting systems. The interviews were transcribed verbatim and analyzed using qualitative content analysis.
Results
Interviewed physicians defined the term “critical incident” differently. Most participants reported that they recorded information on incidents and discussed them in their teams. Several physicians reported taking a ‘pay better attention next time-approach’ to the analysis of incidents. Systematic error management involving incident documentation, analysis, preventive measure development, and follow-up, was the exception.
Conclusions
To promote error management, medical training should include teaching on the topic, so that medical professionals can learn about critical incidents and how to deal with them in an open and structured manner. This would help establish the culture of safety that has long been called for internationally.
Funder
German Federal Ministry of Health
Johann Wolfgang Goethe-Universität, Frankfurt am Main
Publisher
Springer Science and Business Media LLC
Reference31 articles.
1. Gemeinsamer Bundesausschuss. Richtlinie des Gemeinsamen Bundesausschusses über grundsätzliche Anforderungen an ein einrichtungsinternes Qualitätsmanagement für Vertragsärztinnen und Vertragsärzte, Vertragspsychotherapeutinnen und Vertragspsychotherapeuten. medizinische Versorgungszentren, Vertragszahnärztinnen und Vertragszahnärzte sowie zugelassene Krankenhäuser: Qualitätsmanagement-Richtlinie: Qualitätsmanagement-Richtlinie/QM-RL; 17.09.2020.
2. Panesar SS, deSilva D, Carson-Stevens A, Cresswell KM, Salvilla SA, Slight SP, et al. How safe is primary care? A systematic review. BMJ Qual Saf. 2016;25:544–53. https://doi.org/10.1136/bmjqs-2015-004178.
3. Carson-Stevens A, Hibbert P, Williams H, Evans HP, Cooper A, Rees P, et al. Characterising the nature of primary care patient safety incident reports in the England and Wales National Reporting and Learning System: a mixed-methods agenda-setting study for general practice. Southampton (UK): NIHR Journals Library; 2016.
4. Robert Koch-Institut (ed.) Gesundheit in Deutschland. Gesundheitsberichterstattung des Bundes. Gemeinsam getragen von RKI und Destatis. Berlin: RKI; 2015.
5. StatistischesBundesamt. Kostenstruktur bei Arzt- und Zahnarztpraxen sowie Praxen von psychologischen Psychotherapeuten- Fachserie 2 Reihe 1.6.1 - 2019. 2021.