This document summarizes a research study on medical malpractice and errors in the hospital system. The study investigated the lack of education and understanding of tort law among healthcare workers. Medical errors cause up to 98,000 preventable deaths annually in the US. The study aims to determine if providing education on tort law concepts would improve healthcare workers' understanding of negligence and reduce errors. The null hypotheses are that there is no significant difference between errors and lack of education, and that quantitative strategies have no impact on error rates.
Medication Administration Errors at Children's University Hospitals: Nurses P...iosrjce
Medication administration errors(MAE) can threaten patient outcomes and are a dimension of
patient safety directly linked to nursing care. Children are particularly vulnerable to medication errors because
of their unique physiology and developmental needs.
Aims: The present study aims to examine types, stages and causes of medication errors. Barriers of medication
administration errors reporting and its facilitator at pediatric University hospitals from nurses point of view.
Methods: A descriptive study was conducted in Pediatric intensive care units, medical, surgical and urology
ward of children's university hospital at Mansoura University, intensive care units, kidney dialysis at
Abouelrash pediatric hospital and general wards of Elmonaira at Cairo University Hospitals. 80 nurses were
included in the study after fulfilling the criteria of selection. A structured interview questionnaire that consists
of four sections was used.
Results: The highest types of medication errors as reported by studied nurses occurred when the medication is
delivered by the wrong route, the highest stage of medication errors done by nurses was missing of medication
then patient monitoring and administration and the highest cause of medication errors was due to heavy
workload. The results of this study indicated that the strongest perceived barriers to medication administration
errors reporting were fear from consequences of reporting, then managerial factor and then the process of
reporting from the nurse's viewpoint. The nurses agree that identifying benefits of reporting followed agree that
feeling safe about working environment, and agree that good professional relationship with physicians was the
most facilitating factors of reporting medication errors.
Conclusions: It was concluded that medication errors result from interrelated factors, the strongest perceived
barriers to medication administration errors reporting were fear from consequences of reporting, and good
relationship with nurse managers and physicians were the most facilitators of reporting medication errors.
Recommendation: The study recommended that the assessment of medication errors should be done
periodically and in- service training program about medication administrations should be applied
Defensive medicine effect on costs, quality, and access to healthcareAlexander Decker
This document discusses the practice of defensive medicine and its effects. Defensive medicine occurs when doctors order unnecessary tests or procedures in an attempt to reduce malpractice liability. The document finds that defensive medicine increases healthcare costs and can lower quality by leading doctors to avoid high-risk patients or procedures. It also discusses how defensive medicine practices like unnecessary referrals and extra diagnostic tests can limit access to care. The document examines factors that contribute to defensive medicine and its negative impacts on healthcare systems.
1. The document discusses various methods that have been used to track and reduce medical errors, including chart reviews, self-reporting, and direct observation. Errors are often caused by systemic issues rather than individual mistakes.
2. A systems approach aims to identify error sources within healthcare systems and implement solutions like checklists, improved teamwork, and computerized physician order entry.
3. An individual approach provides education to improve cognitive skills and decision-making and reduce biases. Integrating systems solutions and cognitive training shows promise but requires more research.
This study examined Jordanian critical care nurses' perceptions of medication errors through a survey of 83 nurses. The key findings were:
- Nurses perceived the top causes of medication errors to be nurse miscalculating doses, physicians prescribing wrong doses, and illegible physician handwriting.
- There were differences in what nurses considered reportable errors, with more agreement on fast TPN rates but disparate views on withholding digoxin due to late lab results.
- Only 41.8% of nurses believed all errors are reported. Barriers to reporting included fear of manager and peer reactions rather than disciplinary action. Nurses tended to inform physicians instead of completing incident reports.
- The study highlights
This document discusses medical error and strategies to reduce it. It notes that error is common in healthcare due to complex processes and lack of standardization. Reporting and analyzing errors can help identify systemic issues, but error reporting is currently underdeveloped. Information systems could help by providing decision support and monitoring for errors, but must be carefully designed to avoid introducing new latent errors. Overall, reducing medical error requires a systematic approach across organizations to improve safety culture, implement decision aids, and continuously learn from reported errors and close calls.
Medical and Health-Related Errors - The Impact of Recordkeeping upon Patient ...Andrew Sexton
This document summarizes a research proposal that examines whether the conversion to electronic medical recordkeeping will reduce medical errors. The proposal includes a literature review discussing studies that found errors were reduced with computerized billing systems compared to hard copy forms. Other studies found that standardized electronic records improved care coordination, patient safety, and quality. The proposal puts forth several hypotheses to test, including that males and those with less education will be more correlated with errors, while younger individuals and those with more education will be less correlated. The proposed methodology would survey a sample of US adults to collect data to analyze the hypotheses through regression analyses. The goal is to understand how recordkeeping impacts patient well-being and quality of care through medical errors.
INTERNAL MEDICINE ORGANIZATIONS SURVEY INTERNISTS ON MAINTENANCE OF CERTIFICA...abimorg
A survey of internists—physicians practicing internal
medicine—whose board certification was up for renewal in December 2002 found that the most
common reasons for participating in recertification or Maintenance of Certification (MOC) were
to maintain professional image and update knowledge. The survey findings report that 59 percent
of general internists and 60 percent of subspecialists participated to maintain their professional
image. Additionally, 51 percent of general internists and 60 percent of subspecialists participated
to update their medical knowledge. http://www.abim.org/moc/
This document discusses issues with patient misidentification in healthcare and proposes solutions. It notes that patient misidentification can lead to medical errors and harm patients. Interventions like using two patient identifiers, barcoding systems, and staff education on safety protocols may help reduce errors related to improper identification. The importance of ensuring patients receive the correct treatments and medications is emphasized.
Medication Administration Errors at Children's University Hospitals: Nurses P...iosrjce
Medication administration errors(MAE) can threaten patient outcomes and are a dimension of
patient safety directly linked to nursing care. Children are particularly vulnerable to medication errors because
of their unique physiology and developmental needs.
Aims: The present study aims to examine types, stages and causes of medication errors. Barriers of medication
administration errors reporting and its facilitator at pediatric University hospitals from nurses point of view.
Methods: A descriptive study was conducted in Pediatric intensive care units, medical, surgical and urology
ward of children's university hospital at Mansoura University, intensive care units, kidney dialysis at
Abouelrash pediatric hospital and general wards of Elmonaira at Cairo University Hospitals. 80 nurses were
included in the study after fulfilling the criteria of selection. A structured interview questionnaire that consists
of four sections was used.
Results: The highest types of medication errors as reported by studied nurses occurred when the medication is
delivered by the wrong route, the highest stage of medication errors done by nurses was missing of medication
then patient monitoring and administration and the highest cause of medication errors was due to heavy
workload. The results of this study indicated that the strongest perceived barriers to medication administration
errors reporting were fear from consequences of reporting, then managerial factor and then the process of
reporting from the nurse's viewpoint. The nurses agree that identifying benefits of reporting followed agree that
feeling safe about working environment, and agree that good professional relationship with physicians was the
most facilitating factors of reporting medication errors.
Conclusions: It was concluded that medication errors result from interrelated factors, the strongest perceived
barriers to medication administration errors reporting were fear from consequences of reporting, and good
relationship with nurse managers and physicians were the most facilitators of reporting medication errors.
Recommendation: The study recommended that the assessment of medication errors should be done
periodically and in- service training program about medication administrations should be applied
Defensive medicine effect on costs, quality, and access to healthcareAlexander Decker
This document discusses the practice of defensive medicine and its effects. Defensive medicine occurs when doctors order unnecessary tests or procedures in an attempt to reduce malpractice liability. The document finds that defensive medicine increases healthcare costs and can lower quality by leading doctors to avoid high-risk patients or procedures. It also discusses how defensive medicine practices like unnecessary referrals and extra diagnostic tests can limit access to care. The document examines factors that contribute to defensive medicine and its negative impacts on healthcare systems.
1. The document discusses various methods that have been used to track and reduce medical errors, including chart reviews, self-reporting, and direct observation. Errors are often caused by systemic issues rather than individual mistakes.
2. A systems approach aims to identify error sources within healthcare systems and implement solutions like checklists, improved teamwork, and computerized physician order entry.
3. An individual approach provides education to improve cognitive skills and decision-making and reduce biases. Integrating systems solutions and cognitive training shows promise but requires more research.
This study examined Jordanian critical care nurses' perceptions of medication errors through a survey of 83 nurses. The key findings were:
- Nurses perceived the top causes of medication errors to be nurse miscalculating doses, physicians prescribing wrong doses, and illegible physician handwriting.
- There were differences in what nurses considered reportable errors, with more agreement on fast TPN rates but disparate views on withholding digoxin due to late lab results.
- Only 41.8% of nurses believed all errors are reported. Barriers to reporting included fear of manager and peer reactions rather than disciplinary action. Nurses tended to inform physicians instead of completing incident reports.
- The study highlights
This document discusses medical error and strategies to reduce it. It notes that error is common in healthcare due to complex processes and lack of standardization. Reporting and analyzing errors can help identify systemic issues, but error reporting is currently underdeveloped. Information systems could help by providing decision support and monitoring for errors, but must be carefully designed to avoid introducing new latent errors. Overall, reducing medical error requires a systematic approach across organizations to improve safety culture, implement decision aids, and continuously learn from reported errors and close calls.
Medical and Health-Related Errors - The Impact of Recordkeeping upon Patient ...Andrew Sexton
This document summarizes a research proposal that examines whether the conversion to electronic medical recordkeeping will reduce medical errors. The proposal includes a literature review discussing studies that found errors were reduced with computerized billing systems compared to hard copy forms. Other studies found that standardized electronic records improved care coordination, patient safety, and quality. The proposal puts forth several hypotheses to test, including that males and those with less education will be more correlated with errors, while younger individuals and those with more education will be less correlated. The proposed methodology would survey a sample of US adults to collect data to analyze the hypotheses through regression analyses. The goal is to understand how recordkeeping impacts patient well-being and quality of care through medical errors.
INTERNAL MEDICINE ORGANIZATIONS SURVEY INTERNISTS ON MAINTENANCE OF CERTIFICA...abimorg
A survey of internists—physicians practicing internal
medicine—whose board certification was up for renewal in December 2002 found that the most
common reasons for participating in recertification or Maintenance of Certification (MOC) were
to maintain professional image and update knowledge. The survey findings report that 59 percent
of general internists and 60 percent of subspecialists participated to maintain their professional
image. Additionally, 51 percent of general internists and 60 percent of subspecialists participated
to update their medical knowledge. http://www.abim.org/moc/
This document discusses issues with patient misidentification in healthcare and proposes solutions. It notes that patient misidentification can lead to medical errors and harm patients. Interventions like using two patient identifiers, barcoding systems, and staff education on safety protocols may help reduce errors related to improper identification. The importance of ensuring patients receive the correct treatments and medications is emphasized.
This research poster presentation examines the impact of increased protein intake on pressure ulcer prevalence in nursing home patients aged 65 and older with Braden Scale scores between 15-18. The study aims to decrease pressure ulcer rates by providing an extra 30g of protein in a daily smoothie to the sample population. Skin assessments using the Braden Scale will be conducted before and after the 6-week intervention to evaluate changes in pressure ulcer risk levels. The poster outlines the background, PICO question, literature review supporting the benefits of protein supplementation, methods of implementation, and plans for data analysis to determine if the intervention is effective in reducing pressure ulcer prevalence.
This document discusses medication errors, including their scope and causes. It notes that medication errors are a major problem, causing many preventable deaths each year and billions in costs. Common causes of errors include look-alike drug names and packaging, multiple drug concentrations, labeling issues, and time constraints on nurses. High-risk drugs and IV medications are particularly prone to errors. Errors can involve wrong drugs, doses, preparations or contamination. The document outlines various technologies and practices that can help reduce errors, such as electronic prescribing, bar coding, and computerized physician order entry.
This document presents a literature review and proposal to reduce medication errors in a 28-bed rehabilitation unit through the use of an electronic medication administration record (EMAR) over a 30-day period. Studies have shown EMARs can significantly reduce transcription and administration errors compared to handwritten records. The proposal is for physicians to enter all medication orders via the existing EMAR system for 30 days to evaluate if it decreases transcription errors versus the current paper method. Implementing EMARs has been shown to potentially prevent 84% of dosing, frequency and route errors.
This document discusses the ethical aspects of anesthesia care and euthanasia. It covers topics such as informed consent, do not resuscitate orders, truth telling about medical errors, end of life decision making, physician assisted suicide, organ transplantation, medical research ethics, and euthanasia. The document outlines various ethical theories and the four pillars of medical ethics: respect for patient autonomy, beneficence, nonmaleficence, and justice. It also discusses concepts like informed consent, surrogate decision making, conscientious objection, and the ethical treatment of children and animals in medical research.
The document summarizes research on the benefits of clinical pharmacists participating as members of medical teams. Several studies found that including clinical pharmacists reduced mortality rates in hospitals and improved outcomes across disease states. Pharmacists improved medication management by addressing drug-related problems, which led to decreased mortality for conditions like heart attacks. Their interventions enhanced clinical outcomes for diabetes, cardiovascular disorders, and other conditions. Effective implementation of these pharmacy services requires support from healthcare organizations and infrastructure support within facilities.
Sociotechnical Aspects: Clinicians and Technology_ lecture 1_slidesZakCooper1
This lecture focused on medical errors and patient safety. It distinguished between individual "slips" and "mistakes" as well as system errors. Several types of medical errors were examined like medication errors and wrong site surgeries. Efforts to improve patient safety through initiatives like medication reconciliation were also discussed. The lecture concluded by reviewing organizations driving improvements in patient safety and quality of care.
- Falls are the most common adverse event in inpatient settings in the US, with 424,000 deaths annually and 37.3 million medical attendances resulting from falls.
- At New York Presbyterian Hospital's 5C medical-surgical unit, the fall rate is approximately 3 falls per month, with 3 of those falls resulting in injury over the past year.
- By designating a "falls champion" nurse on each shift to oversee fall prevention protocols and education, the authors hope to reduce fall rates and improve patient safety compared to the unit's current fall prevention practices of bed alarms, bracelets, and signage.
Genomic variation partially explains interindividual variability in responses to perioperative stressors and drugs. The perioperative period represents an opportunity to implement precision medicine strategies through preemptive profiling, risk stratification incorporating genetics, and pharmacogenomics-guided drug selection. Specific genetic polymorphisms have shown associations with increased risk of perioperative adverse events like myocardial infarction and atrial fibrillation.
The document discusses computer-based patient records for anesthesia. It notes that Cushing-Codman made the first ether chart for keeping anesthesia records. Computerization allows for easy retrieval of data which is an important advantage. Hospital information systems can have a monolithic or "best-in-breed" model. The monolithic system has smooth interoperability but some components may be inferior. Electronic health records provide tools for provider communication and access to population data for research. Specialty electronic health records have been developed including for anesthesia, emergency departments, and intensive care units.
Patient safety is a fundamental principle of healthcare. Medical errors harm millions of patients annually, costing billions of dollars. Up to 15% of hospital activity results from preventable adverse events, many of which are infections, pressure ulcers, or complications from unsafe medication practices and medical radiation. Investing in improved safety measures like hand hygiene could reduce patient harm and healthcare costs significantly.
Controladores y estrategias para evitar la sobreutilización sanitaria en Aten...Javier González de Dios
Objectives: Identify the sources of overuse from the point of view of the Spanish primary care professionals, and
analyse the frequency of overuse due to pressure from patients in addition to the responses when professionals
face these demands.
Design: A cross-sectional study.
Setting: Primary care in Spain.
Participants: A non-randomised sample of 2201 providers (general practitioners, paediatricians and nurses) was
recruited during the survey.
Primary and secondary outcome measures: The frequency, causes and responsibility for overuse, the frequency that patients demand unnecessary tests or procedures, the profile of the most demanding patients, and arguments for dissuading the patient.
Results: In all, 936 general practitioners, 682 paediatricians and 286 nurses replied (response rate 18.6%). Patient requests (67%) and defensive medicine (40%) were the most cited causes of overuse. Five hundred and twenty-two (27%) received requests from their patients almost every day for unnecessary tests or procedures, and 132 (7%) recognised granting the requests. The lack of time in consultation, and information about new medical advances and treatments
that patients could find on printed and digital media, contributed to the professional’s inability to adequately
counter this pressure by patients. Clinical safety (49.9%) and evidence (39.4%) were the arguments that dissuaded patients from their requests the most. Cost savings was not a convincing argument (6.8%), above all for paediatricians (4.3%). General practitioners resisted more pressure from their patients (x2 =88.8, P<0.001,
percentage difference (PD)=17.0), while nurses admitted to carrying out more unnecessary procedures (x2 =175.7,
P<0.001, PD=12.3).
Conclusion: Satisfying the patient and patient uncertainty about what should be done and defensive medicine practices explains some of the frequent causes of overuse. Safety arguments are useful to dissuade patients from their requests.
This document discusses medical errors and increasing patient safety. It summarizes several studies that found medical errors are common, with rates of adverse events from around 3-17% of hospital admissions. Errors result in tens of thousands of unnecessary deaths annually. Most errors are due to cognitive mistakes and "system" failures rather than individual negligence. To improve safety, the document argues we must think of errors as systems failures and implement strategies like checklists, standardized procedures, training, and a culture where safety is a top priority and errors are reported to fix underlying issues rather than blame individuals.
- A study compared rates of preventable adverse drug events (ADEs) in intensive care units (ICUs) vs. non-ICUs at two hospitals over 6 months.
- The unadjusted ADE rate was twice as high in ICUs, but when adjusted for number of drugs, there was no difference between ICUs and non-ICUs.
- Preventable ADEs occurred due to normal systems failures like poor communication rather than overworked individuals, showing the need for systems solutions over blaming individuals.
This document discusses several enduring problems in healthcare systems including uncertainty about clinical effectiveness due to poor quality research, persistent variations in clinical practice, patient safety issues, reluctance to manage skill mix, and poor outcome measurement. It also outlines some achievements of the UK healthcare system such as the establishment of NICE to evaluate clinical and cost effectiveness, introduction of targets to reduce wait times, and beginning to benchmark safety incidents. However, it notes continuous reorganizations have not been properly evaluated and there is a need for greater focus on improving average performance and ensuring best practices are universally adopted.
An emergency department quality improvement projectyasmeenzulfiqar
The document discusses improving vital sign documentation during triage in emergency departments. It aims to investigate factors affecting vital sign data quality during measurement and documentation, and provide recommendations for improvement. A literature review found that timely and accurate vital sign documentation is important for identifying deteriorating patients. However, studies on nursing workflows and documentation of vital signs are limited. The objective is to study nurses' vital sign documentation process through a questionnaire of nurses and analysis of the data. Results showed teamwork and quality improvement efforts like education and training can enhance compliance with vital sign documentation standards during triage. Recommendations include departments addressing challenges in measurement time and reviewing results to improve performance.
4 replies one for each claudiamajor disasters and emeAASTHA76
This document discusses health policies and their impact on nursing practice, particularly during disasters and emergencies. It notes that health policies provide guidelines for patient care during normal times and can act as a "guiding light" during abnormal situations like disasters. Nurses must be trained on protocols and have a general understanding of what to do in emergencies in order to respond rapidly and effectively. The document also emphasizes that nurses should feel confident in their actions during emergencies and that their experiences can help inform future health policies.
This document discusses the need to harmonize the process for reporting potential conflicts of interest in health care and life sciences. It notes that individuals are currently required to provide this information to various organizations in non-identical, time-consuming ways. The document proposes creating a common set of disclosure elements and a standardized digital format that individuals can use to easily report relationships to multiple requesting organizations. This would reduce burden on individuals and allow organizations to access standardized data more efficiently. It outlines goals and approaches discussed by working groups to define common elements and a process for centralized storage and retrieval of disclosure information.
The document proposes implementing a new triage system called the Comprehensive Triage Acuity System at a VA walk-in clinic to improve patient flow and outcomes. The system uses a 5-level scale to assess physical, social, and health needs and prioritize patients needing emergent, urgent, or non-urgent care. All clinic staff will receive training. The proposal aims to compare utilization rates and homeless veteran numbers before and after implementation to evaluate the system's effects.
Article‘the line betweenintervention and abuse’– autisAASTHA76
This document summarizes and analyzes the debates surrounding Applied Behavior Analysis (ABA) as a treatment for autism. It outlines how ABA emerged from behaviorism in the mid-20th century and was pioneered by Ole Ivar Lovaas, who used aversive techniques like beatings and shocks. While Lovaas' early work was controversial due to these methods, ABA became widely accepted after Lovaas published results in 1987 showing improvements. However, the neurodiversity movement now rejects ABA, arguing that autism is a natural difference rather than a disorder needing treatment, and that ABA can be psychologically harmful. The document examines both sides of the ongoing debates around ABA.
This course syllabus outlines the details of a rhetoric and composition course, including objectives, assignments, grading, and policies. Students will examine communication practices and apply them to their own compositions in various modes. Major assignments include a rhetorical analysis essay, research process portfolio, researched argument essay, and multimodal project. The course aims to develop skills in persuasive writing, research, and information literacy. Regular responses and participation are required along with adherence to netiquette and attendance guidelines. Late or missing work impacts grades significantly.
This research poster presentation examines the impact of increased protein intake on pressure ulcer prevalence in nursing home patients aged 65 and older with Braden Scale scores between 15-18. The study aims to decrease pressure ulcer rates by providing an extra 30g of protein in a daily smoothie to the sample population. Skin assessments using the Braden Scale will be conducted before and after the 6-week intervention to evaluate changes in pressure ulcer risk levels. The poster outlines the background, PICO question, literature review supporting the benefits of protein supplementation, methods of implementation, and plans for data analysis to determine if the intervention is effective in reducing pressure ulcer prevalence.
This document discusses medication errors, including their scope and causes. It notes that medication errors are a major problem, causing many preventable deaths each year and billions in costs. Common causes of errors include look-alike drug names and packaging, multiple drug concentrations, labeling issues, and time constraints on nurses. High-risk drugs and IV medications are particularly prone to errors. Errors can involve wrong drugs, doses, preparations or contamination. The document outlines various technologies and practices that can help reduce errors, such as electronic prescribing, bar coding, and computerized physician order entry.
This document presents a literature review and proposal to reduce medication errors in a 28-bed rehabilitation unit through the use of an electronic medication administration record (EMAR) over a 30-day period. Studies have shown EMARs can significantly reduce transcription and administration errors compared to handwritten records. The proposal is for physicians to enter all medication orders via the existing EMAR system for 30 days to evaluate if it decreases transcription errors versus the current paper method. Implementing EMARs has been shown to potentially prevent 84% of dosing, frequency and route errors.
This document discusses the ethical aspects of anesthesia care and euthanasia. It covers topics such as informed consent, do not resuscitate orders, truth telling about medical errors, end of life decision making, physician assisted suicide, organ transplantation, medical research ethics, and euthanasia. The document outlines various ethical theories and the four pillars of medical ethics: respect for patient autonomy, beneficence, nonmaleficence, and justice. It also discusses concepts like informed consent, surrogate decision making, conscientious objection, and the ethical treatment of children and animals in medical research.
The document summarizes research on the benefits of clinical pharmacists participating as members of medical teams. Several studies found that including clinical pharmacists reduced mortality rates in hospitals and improved outcomes across disease states. Pharmacists improved medication management by addressing drug-related problems, which led to decreased mortality for conditions like heart attacks. Their interventions enhanced clinical outcomes for diabetes, cardiovascular disorders, and other conditions. Effective implementation of these pharmacy services requires support from healthcare organizations and infrastructure support within facilities.
Sociotechnical Aspects: Clinicians and Technology_ lecture 1_slidesZakCooper1
This lecture focused on medical errors and patient safety. It distinguished between individual "slips" and "mistakes" as well as system errors. Several types of medical errors were examined like medication errors and wrong site surgeries. Efforts to improve patient safety through initiatives like medication reconciliation were also discussed. The lecture concluded by reviewing organizations driving improvements in patient safety and quality of care.
- Falls are the most common adverse event in inpatient settings in the US, with 424,000 deaths annually and 37.3 million medical attendances resulting from falls.
- At New York Presbyterian Hospital's 5C medical-surgical unit, the fall rate is approximately 3 falls per month, with 3 of those falls resulting in injury over the past year.
- By designating a "falls champion" nurse on each shift to oversee fall prevention protocols and education, the authors hope to reduce fall rates and improve patient safety compared to the unit's current fall prevention practices of bed alarms, bracelets, and signage.
Genomic variation partially explains interindividual variability in responses to perioperative stressors and drugs. The perioperative period represents an opportunity to implement precision medicine strategies through preemptive profiling, risk stratification incorporating genetics, and pharmacogenomics-guided drug selection. Specific genetic polymorphisms have shown associations with increased risk of perioperative adverse events like myocardial infarction and atrial fibrillation.
The document discusses computer-based patient records for anesthesia. It notes that Cushing-Codman made the first ether chart for keeping anesthesia records. Computerization allows for easy retrieval of data which is an important advantage. Hospital information systems can have a monolithic or "best-in-breed" model. The monolithic system has smooth interoperability but some components may be inferior. Electronic health records provide tools for provider communication and access to population data for research. Specialty electronic health records have been developed including for anesthesia, emergency departments, and intensive care units.
Patient safety is a fundamental principle of healthcare. Medical errors harm millions of patients annually, costing billions of dollars. Up to 15% of hospital activity results from preventable adverse events, many of which are infections, pressure ulcers, or complications from unsafe medication practices and medical radiation. Investing in improved safety measures like hand hygiene could reduce patient harm and healthcare costs significantly.
Controladores y estrategias para evitar la sobreutilización sanitaria en Aten...Javier González de Dios
Objectives: Identify the sources of overuse from the point of view of the Spanish primary care professionals, and
analyse the frequency of overuse due to pressure from patients in addition to the responses when professionals
face these demands.
Design: A cross-sectional study.
Setting: Primary care in Spain.
Participants: A non-randomised sample of 2201 providers (general practitioners, paediatricians and nurses) was
recruited during the survey.
Primary and secondary outcome measures: The frequency, causes and responsibility for overuse, the frequency that patients demand unnecessary tests or procedures, the profile of the most demanding patients, and arguments for dissuading the patient.
Results: In all, 936 general practitioners, 682 paediatricians and 286 nurses replied (response rate 18.6%). Patient requests (67%) and defensive medicine (40%) were the most cited causes of overuse. Five hundred and twenty-two (27%) received requests from their patients almost every day for unnecessary tests or procedures, and 132 (7%) recognised granting the requests. The lack of time in consultation, and information about new medical advances and treatments
that patients could find on printed and digital media, contributed to the professional’s inability to adequately
counter this pressure by patients. Clinical safety (49.9%) and evidence (39.4%) were the arguments that dissuaded patients from their requests the most. Cost savings was not a convincing argument (6.8%), above all for paediatricians (4.3%). General practitioners resisted more pressure from their patients (x2 =88.8, P<0.001,
percentage difference (PD)=17.0), while nurses admitted to carrying out more unnecessary procedures (x2 =175.7,
P<0.001, PD=12.3).
Conclusion: Satisfying the patient and patient uncertainty about what should be done and defensive medicine practices explains some of the frequent causes of overuse. Safety arguments are useful to dissuade patients from their requests.
This document discusses medical errors and increasing patient safety. It summarizes several studies that found medical errors are common, with rates of adverse events from around 3-17% of hospital admissions. Errors result in tens of thousands of unnecessary deaths annually. Most errors are due to cognitive mistakes and "system" failures rather than individual negligence. To improve safety, the document argues we must think of errors as systems failures and implement strategies like checklists, standardized procedures, training, and a culture where safety is a top priority and errors are reported to fix underlying issues rather than blame individuals.
- A study compared rates of preventable adverse drug events (ADEs) in intensive care units (ICUs) vs. non-ICUs at two hospitals over 6 months.
- The unadjusted ADE rate was twice as high in ICUs, but when adjusted for number of drugs, there was no difference between ICUs and non-ICUs.
- Preventable ADEs occurred due to normal systems failures like poor communication rather than overworked individuals, showing the need for systems solutions over blaming individuals.
This document discusses several enduring problems in healthcare systems including uncertainty about clinical effectiveness due to poor quality research, persistent variations in clinical practice, patient safety issues, reluctance to manage skill mix, and poor outcome measurement. It also outlines some achievements of the UK healthcare system such as the establishment of NICE to evaluate clinical and cost effectiveness, introduction of targets to reduce wait times, and beginning to benchmark safety incidents. However, it notes continuous reorganizations have not been properly evaluated and there is a need for greater focus on improving average performance and ensuring best practices are universally adopted.
An emergency department quality improvement projectyasmeenzulfiqar
The document discusses improving vital sign documentation during triage in emergency departments. It aims to investigate factors affecting vital sign data quality during measurement and documentation, and provide recommendations for improvement. A literature review found that timely and accurate vital sign documentation is important for identifying deteriorating patients. However, studies on nursing workflows and documentation of vital signs are limited. The objective is to study nurses' vital sign documentation process through a questionnaire of nurses and analysis of the data. Results showed teamwork and quality improvement efforts like education and training can enhance compliance with vital sign documentation standards during triage. Recommendations include departments addressing challenges in measurement time and reviewing results to improve performance.
4 replies one for each claudiamajor disasters and emeAASTHA76
This document discusses health policies and their impact on nursing practice, particularly during disasters and emergencies. It notes that health policies provide guidelines for patient care during normal times and can act as a "guiding light" during abnormal situations like disasters. Nurses must be trained on protocols and have a general understanding of what to do in emergencies in order to respond rapidly and effectively. The document also emphasizes that nurses should feel confident in their actions during emergencies and that their experiences can help inform future health policies.
This document discusses the need to harmonize the process for reporting potential conflicts of interest in health care and life sciences. It notes that individuals are currently required to provide this information to various organizations in non-identical, time-consuming ways. The document proposes creating a common set of disclosure elements and a standardized digital format that individuals can use to easily report relationships to multiple requesting organizations. This would reduce burden on individuals and allow organizations to access standardized data more efficiently. It outlines goals and approaches discussed by working groups to define common elements and a process for centralized storage and retrieval of disclosure information.
The document proposes implementing a new triage system called the Comprehensive Triage Acuity System at a VA walk-in clinic to improve patient flow and outcomes. The system uses a 5-level scale to assess physical, social, and health needs and prioritize patients needing emergent, urgent, or non-urgent care. All clinic staff will receive training. The proposal aims to compare utilization rates and homeless veteran numbers before and after implementation to evaluate the system's effects.
Article‘the line betweenintervention and abuse’– autisAASTHA76
This document summarizes and analyzes the debates surrounding Applied Behavior Analysis (ABA) as a treatment for autism. It outlines how ABA emerged from behaviorism in the mid-20th century and was pioneered by Ole Ivar Lovaas, who used aversive techniques like beatings and shocks. While Lovaas' early work was controversial due to these methods, ABA became widely accepted after Lovaas published results in 1987 showing improvements. However, the neurodiversity movement now rejects ABA, arguing that autism is a natural difference rather than a disorder needing treatment, and that ABA can be psychologically harmful. The document examines both sides of the ongoing debates around ABA.
This course syllabus outlines the details of a rhetoric and composition course, including objectives, assignments, grading, and policies. Students will examine communication practices and apply them to their own compositions in various modes. Major assignments include a rhetorical analysis essay, research process portfolio, researched argument essay, and multimodal project. The course aims to develop skills in persuasive writing, research, and information literacy. Regular responses and participation are required along with adherence to netiquette and attendance guidelines. Late or missing work impacts grades significantly.
O documento é uma homenagem a professores e suas qualidades desejáveis como mente brilhante, paciência infinita e amor incondicional por contribuir para um futuro mais justo e pacífico. O autor expressa o desejo de fazer parte da vida de um aluno e receber o orgulho de ter ensinado como esses professores mencionados e tantos outros.
Un torneo de vóley femenino será organizado por el equipo femenino del Complejo Papelero en colaboración con la Dirección de Deportes de la Municipalidad de Libertador General San Martín. El evento tendrá lugar el domingo 19 de enero a las 9:30 en el Complejo Papelero y contará con la participación de equipos locales así como de Jujuy y Caimancito. Todos están invitados a asistir.
Haiku Deck is a presentation tool that allows users to create Haiku style slideshows. The tool encourages users to get started making their own Haiku Deck presentations which can be shared on SlideShare. In just a few sentences, it pitches the idea of using Haiku Deck to easily create visually engaging slideshows.
This lesson plan aims to teach older adults with diabetes how to make healthy food choices when dining out. The 30-minute lesson will cover identifying sources of hidden sugars, substituting non-starchy vegetables for starches, and reducing portion sizes. The teacher will use examples like pasta dishes, burgers and fries, and Mexican food to demonstrate substitution options. An assessment will evaluate if learners meet the objectives of identifying ways to increase nutrients and reduce carbohydrates while dining out.
Este documento presenta el horario escolar de la primera clase de la escuela secundaria. El horario muestra las asignaturas que los estudiantes tendrán cada día de la semana, desde el lunes hasta el viernes, y los profesores a cargo de cada asignatura. También incluye un resumen de las asignaturas y profesores.
Este documento proporciona contactos para Carla Lechevalier y Silvia Salcedo de Virtual Market, quienes pueden asesorar a marcas sobre oportunidades en el canal tradicional y cómo incrementar sus ventas. También incluye números de teléfono y correo electrónico de contacto, así como información sobre seguir a Virtual Market y contactar a Patricia Arzaluz.
This hotel in Philadelphia offers 194 guest rooms, 19 spa rooms, and 17 suites. It provides amenities like Wi-Fi, evening wine hours, morning coffee service, and pet-friendly accommodations. The hotel has over 6,000 square feet of event space including 5 meeting rooms and a ballroom. It is located in Rittenhouse Square near the airport and train station and offers dining and packages to accommodate business meetings and events.
Naveen Joy is seeking an opportunity in IT where he can apply 5+ years of experience. He has worked as an IT Infrastructure Support Engineer, IT System Engineer, and Application Support Engineer for various companies in India and Dubai. His experience includes installing and troubleshooting hardware, software, and networks. He also has experience with user account management, software licensing, and providing technical support. He holds a B.Sc. in Computer Science and certifications in Windows Server and computer hardware.
1) O documento descreve as principais alterações na NBR-14653-2 relacionadas a modelos de regressão linear para avaliação imobiliária, incluindo a identificação e tratamento de variáveis, pressupostos do modelo e graus de fundamentação do laudo.
2) Foram alterados os critérios para o número mínimo de dados a serem utilizados no modelo em função do número de variáveis, assim como os níveis de significância para rejeição de hipóteses.
3) Agora a verificação de autocorrelação pode ser feita
A DMRI é uma doença degenerativa da mácula relacionada à idade que causa perda da visão. Fatores de risco incluem tabagismo, hipertensão, hipercolesterolemia e exposição a raios UV. Uma dieta rica em ômega-3, antioxidantes e atividade física pode ajudar a prevenir a DMRI, enquanto o controle do colesterol HDL e LDL também é importante.
O documento descreve as atividades realizadas em 2013 por uma escola, incluindo: a) ações de promoção da inclusão social de pessoas com deficiência; b) atividades na comunidade sobre preservação ambiental; c) eventos para promover a interação escola-comunidade. As atividades planejadas para 2014 incluem: a) apoio a alunos com deficiência; b) exposição sobre a caatinga; c) reuniões com conselho escolar e famílias.
This document provides an overview of magnesium, including its history of discovery, sources, absorption, functions in the body, recommended intake levels, and current research. Magnesium acts as a cofactor in many enzyme reactions and plays important roles in nerve signaling, cardiovascular health, and bone structure. While deficiency is rare, emerging research suggests higher intake may help prevent conditions like diabetes and heart disease. Improved methods of diagnosing magnesium deficiency are also being explored.
O documento descreve as reuniões realizadas e projetadas para o Conselho Escolar em 2013-2014. Em 2013, as reuniões trataram principalmente de homologações, avaliações e atualizações. Em 2014, as reuniões projetadas também incluirão essas atividades, além de controle social e fiscalização de recursos.
MHA6999 SEMINAR IN HEALTHCARE CASES-- WEEK 2 LECTURE, DISCUSSION, DioneWang844
MHA6999 SEMINAR IN HEALTHCARE CASES-- WEEK 2 LECTURE, DISCUSSION, AND PROJECT INSTRUCTIONS
Page | 1
Quality
Nearly fifteen years ago, the Institute of Medicine published the “To Err Is Human” report, which exposed the substantial impact of medical errors in the US healthcare system and called for a dramatic system change, including an improved understanding of those errors (McCarthy, Tuiskula, Driscoll, & Davis, 2017). Medical errors are considered to be failure to achieve the original goal or plan of action, and these errors may range from a patient falls to a mistake in the operating room. Not only do medical errors cause harm to the patient and jeopardize the patient’s trust, but they also cause a financial strain for the health system (“To Err is Human,” 1999). One of the contributing factors to medical errors is the lack of effective communication between doctors who are treating the same patient. This results in healthcare providers overprescribing medications for patients as well as increases the possibility of a patient having unnecessary tests or procedures performed. The report’s four-tiered approach includes:
· Focusing on creating a stronger foundation of education on patient safety
· Mandating a nationwide reporting system to encourage timely reporting of errors
· Increasing the standards of performance for healthcare providers
· Taking advantage of the security that safety systems offer (“To Err is Human,” 1999)
Creating a strong educational foundation for patient safety is most important. Healthcare personnel are much more likely to actively participate in reporting systems, encourage one another to perform at a higher level, and take advantage of safety systems when they are well educated on patient safety and the implications of medical errors. The reporting system seems to provide the least amount of impact on patient safety as they can result in losing patient trust in certain healthcare systems. The healthcare system as a whole has made progress in establishing a safe environment for patients when they are in need of care.
Challenges for Patient Safety and Steps for Improvement
Despite continuing evidence of problems in patient safety and gaps between the care that patients receive and the evidence about what they should receive, efforts to improve quality in healthcare show mostly inconsistent and patchy results.
Tap each image to know more.
Data Collection and Monitoring Systems
This always takes much more time and energy than anyone anticipates. It is worth investing heavily in data from the outset. Assess local systems, train people, and have quality assurance.
Tribalism and Lack of Staff Engagement
Overcoming a perceived lack of ownership and professional or disciplinary boundaries can be very difficult. Clarify who owns the problem and solution, agree roles and responsibilities at the outset, work to common goals, and use shared language.
Convince People That There's a Problem
Use hard data to secure emotional e ...
Running head McVeigh– Defensive Medicine Essay 1 1 .docxcowinhelen
Running head: McVeigh– Defensive Medicine Essay 1
1
It has been said that the fear of medical liability drives healthcare providers, particularly
physicians, to unnecessarily order diagnostic tests and to perform treatments and procedures
that may not be necessary, simply to ensure that nothing is left undone. Is this in fact the case?
Defend position on this premise using literature.
Langley McVeigh, MHA, FACHE
May 23, 2017
McVeigh - Defensive Medicine 2
Yes, defensive medicine is practiced in the United States. However, it is important to
understand: (1) what impact it has on healthcare expenditures (2) to what degree does it occur
(prevalence) and (3) if so, what can be done to prevent it?
As an emergency services administrator for a Level 1 trauma center, experience has led
me to understand the dynamic influencing physicians in their clinical decision making process.
Ideally, this process should be void of non-clinical bias or influence. However, this is not the
case in many circumstances. Physicians are considering risk and liability when ordering tests
and procedures. This risk management, or risk mis-management, phenomenon is called
defensive medicine. By definition, these occurrences are medical practices intended to
exonerate practitioners from liability with limited or without medical benefit to the patient
(Sethi et al, 2012). Physicians have been directed by health policy to provide value based care,
but defensive medicine practice works against this care model.
There have been studies conducted measuring physician attitudes towards tort reform
and defensive medicine practices. While studies show physicians, especially high risk medical
specialists, regularly practicing defensive medicine, the cost implications are unclear.
Furthermore, proposed reforms to the medical tort system must be investigated. Some have
proposed to completely do away with the medical tort litigation and insurance system,
replacing it with a system similar to workman’s compensation models. While it may be a reflex
mechanism to use cost as a metric to measure results of defensive medicine practices, patient
outcomes and quality of life implications must also be measured. The patient is the one who is
being subjected to additional and unwarranted procedures.
McVeigh - Defensive Medicince 3
According to a survey of 2000 orthopedic surgeons in 2010 (Sethi et al, 2012), of the
1214 respondents, 96% admitted to have practiced defensive medicine by ordering labs,
imaging studies, specialist referrals, and inpatient admissions. Many surgeons confided this was
done to avoid malpractice claims. These prescriptions offered little no benefit to patient
outcomes, and contrary to the current posture of value based practice in our health care
system. This additional intervention is costly, at an inconvenience to the patient, and may carry
additional health risk. As a reflex, one may think of ...
1. The document discusses TeamSTEPPS, a training initiative to improve teamwork and communication in healthcare to enhance patient safety and outcomes.
2. TeamSTEPPS provides a framework and curriculum to teach core teamwork competencies including leadership, situation monitoring, mutual support and communication.
3. Research has shown that adopting a TeamSTEPPS approach and strengthening teamwork can reduce medical errors and preventable deaths, though widespread changes have been slow to be implemented across the healthcare system.
The document discusses a study that found aviation-based crew resource management training improved patient safety behaviors like checklist use and incident reporting in hospital staff over several years. The training led to increased empowerment scores and a sustained culture of safety. While errors still occur, physician-led programs may be more effective than penalties at improving safety.
Reply 1 he safety of our patients is an important.docxwrite30
Patient safety is critical in healthcare and focuses on preventing medical errors that can harm patients. A 1999 report found that up to 100,000 patients die each year due to preventable errors. This led to initiatives like the Agency for Healthcare Research and Quality to develop tools to improve safety. However, errors are increasingly common in outpatient settings. Reasons include issues with information flow during patient handoffs between providers and human factors like poor documentation that can lead to missed diagnoses or medication errors. Reducing errors requires improved communication and ensuring healthcare workers have the proper expertise.
NURS 438 Trends And Issues In Nursing And Health Systems.docxstirlingvwriters
This document discusses trends and issues related to medical errors in nursing and health systems. It outlines several common causes of medical errors, including communication problems, inadequate information flow, and technical errors. Communication issues between nurses and patients can lead to medication errors, while inadequate discharge instructions and a lack of information for patients post-hospitalization can also result in errors. Technical failures of medical equipment during procedures have caused patient injuries and deaths. Reducing these types of errors will help improve safety and outcomes in healthcare.
November 1999I N S T I T U T E O F M E D I C I N E S.docxIlonaThornburg83
November 1999
I N S T I T U T E O F M E D I C I N E
Shaping the Future for Health
TO ERR IS HUMAN:
BUILDING A SAFER HEALTH SYSTEM
Health care in the United States is not as safe as it should be--and can be. At least 44,000 people, and perhaps as many as 98,000 people, die in hospitals each year as a result of medical errors that could have
been prevented, according to estimates from two major studies. Even using
the lower estimate, preventable medical errors in hospitals exceed attributable
deaths to such feared threats as motor-vehicle wrecks, breast cancer, and
AIDS.
Medical errors can be defined as the failure of a planned action to be
completed as intended or the use of a wrong plan to achieve an aim. Among
the problems that commonly occur during the course of providing health care
are adverse drug events and improper transfusions, surgical injuries and
wrong-site surgery, suicides, restraint-related injuries or death, falls, burns,
pressure ulcers, and mistaken patient identities. High error rates with serious
consequences are most likely to occur in intensive care units, operating rooms,
and emergency departments.
Beyond their cost in human lives, preventable medical errors exact
other significant tolls. They have been estimated to result in total costs (in
cluding the expense of additional care necessitated by the errors, lost income
and household productivity, and disability) of between $17 billion and $29
billion per year in hospitals nationwide. Errors also are costly in terms of loss
of trust in the health care system by patients and diminished satisfaction by
both patients and health professionals. Patients who experience a long hospi
tal stay or disability as a result of errors pay with physical and psychological
discomfort. Health professionals pay with loss of morale and frustration at
not being able to provide the best care possible. Society bears the cost of er
rors as well, in terms of lost worker productivity, reduced school attendance
by children, and lower levels of population health status.
A variety of factors have contributed to the nation’s epidemic of medi
cal errors. One oft-cited problem arises from the decentralized and frag
mented nature of the health care delivery system--or “nonsystem,” to some
observers. When patients see multiple providers in different settings, none of
whom has access to complete information, it becomes easier for things to go
Errors…are costly
in terms of loss of
trust in the health
care system by pa
tients and dimin
ished satisfaction
by both patients
and health profes
sionals.
Types of Errors
Diagnostic
Error or delay in diagnosis
Failure to employ indicated tests
Use of outmoded tests or therapy
Failure to act on results of monitoring or testing
Treatment
Error in the performance of an operation, procedure, or test
Error in administering the treatment
Error in the dose or method of using a drug
Avoidable delay in treatmen.
1) The study reviewed 122 malpractice claims from 4 insurers involving missed or delayed diagnoses in the emergency department.
2) 79 claims (65%) involved missed ED diagnoses that harmed patients, with 48% resulting in serious harm and 39% in death.
3) The leading causes of missed diagnoses were failures to order appropriate diagnostic tests or perform adequate exams, incorrect test interpretations, and failures to order appropriate consultations. The most common contributing factors were cognitive errors, patient factors, lack of supervision, and excessive workload.
MSN 5650 Miami Regional University Reducing Hospital Readmission Presentation...bkbk37
This document discusses reducing hospital readmissions and improving quality of care. It identifies some key causes of hospital readmissions, such as medication errors, non-compliance by patients, and inappropriate transition from hospital to home. It notes that readmissions negatively impact quality of care and that hospitals have implemented programs to reduce readmissions. The document discusses the importance of clearly explaining medical instructions to patients and ensuring a smooth transition from hospital to home care through follow-up appointments and support.
Nephrology Nursing Journal September-October 2014 Vol. 41, No. 5 447
Patient Safety and Patient Safety
Culture: Foundations of Excellent
Health Care Delivery
Primum non nocere. First do no harm.
Patient safety forms the founda-tion of healthcare delivery justas biological, physiological,and safety needs form the
foundation of Maslow’s hierarchy
(Maslow, 1954). Little else can be
accomplished if the patient does not
feel safe or is, in fact, not safe. But the
healthcare system is extremely com-
plex, and ensuring patient safety
requires the ongoing, focused efforts
of every member of the healthcare
team.
Patient safety moved to the fore-
front in health care with the release in
1999 of the Institute of Medicine (IOM)
landmark report, To Err is Human:
Building a Safer Health System, which
estimated that annually in the United
States, up to one million people were
injured and 98,000 died as a result of
medical errors (IOM, 2000). The re -
port caught the attention of the media,
and there were headlines across the
nation about the safety (or lack of safe-
ty) for patients in healthcare organiza-
tions. In 2013, James updated the esti-
mate of patient harms associated with
Beth Ulrich
Tamara Kear
Continuing Nursing
Education
Beth Ulrich, EdD, RN, FACHE, FAAN, is
Editor, the Nephrology Nursing Journal, and a
Professor, the University of Texas Health Science
Center at Houston School of Nursing. She is a Past
President of ANNA and a member of ANNA’s
Sand Dollar Chapter. She may be contacted direct-
ly via email at [email protected]
Tamara Kear, PhD, RN, CNS, CNN, is an
Assistant Professor of Nursing, Villanova
University, Villanova, PA, and a Nephrology
Nurse, Liberty Dialysis. She is on the Editorial
Board for the Nephrology Nursing Journal,
serves as the ANNA Research Committee chairper-
son, and is a member of ANNA’s Keystone Chapter.
Statements of Disclosure: Please refer to page
457.
Note: Additional statements of disclosure and
instructions for CNE evaluation can be found on
page 457.
This offering for 1.4 contact hours is provided by the American Nephrology Nurses’
Association (ANNA).
American Nephrology Nurses’ Association is accredited as a provider of continuing nursing
education by the American Nurses Credentialing Center Commission on Accreditation.
ANNA is a provider approved by the California Board of Registered Nursing, provider number
CEP 00910.
This CNE article meets the Nephrology Nursing Certification Commission’s (NNCC’s) continu-
ing nursing education requirements for certification and recertification.
Copyright 2014 American Nephrology Nurses’ Association
Ulrich, B., & Kear, T. (2014). Patient safety and patient safety culture: Foundations of ex -
cellent health care delivery. Nephrology Nursing Journal, 41(5), 447-456, 505.
In 1999, patient safety moved to the forefront of health care based upon astonishing sta-
tistics and a landmark report released by the Institute of Medicine (IOM). This report,
To Err.
This document discusses the costs of medical errors and efforts to reduce preventable hospital-acquired conditions (HACs). It notes that medical errors may cause up to 98,000 deaths per year costing up to $29 billion annually. Hospitals have little incentive to improve safety due to externalizing most error costs. In response, policies began denying Medicare/Medicaid payments for treatments from certain HACs considered preventable. This policy was expanded in 2012/2015 and may reduce payments to hospitals with the highest rates of HACs. The goal is to incentivize greater patient safety.
Running head A REVIEW OF KEY CURRENT HEALTHCARE ISSUES QUALITY A.docxtoddr4
Running head: A REVIEW OF KEY CURRENT HEALTHCARE ISSUES: QUALITY AND VALUE IN THE U.S’S HEALTHCARE SYSTEM 1
A REVIEW OF KEY CURRENT HEALTHCARE ISSUES: QUALITY AND VALUE IN THE U.S’S HEALTHCARE SYSTEM
A Review of Key Current Healthcare Issues: Quality and Value in the U.S's Healthcare System
Student's Name
Institution Affiliation
Date
A Review of Key Current Healthcare Issues: Quality and Value in the U.S's Healthcare System
Healthcare regulations, funds, workload, and technology continue to complicate and inconvenient the U.S healthcare system. However, the quality and value of care tops. In the United States of America, despite significant healthcare transformation efforts, poor care lingers a considerable concern.
America is second to none in terms of healthcare expenditure across the globe. Ironically, evidence shows that its citizens do not receive the most appropriate care, or at least, which they need. For instance, Graban (2018) documents that preventive care is underutilized in the country, which is escalating the budget of managing advanced diseases. On the other hand, patients of chronic ailments such as diabetes, hypertension, and cardiac complications, do not also usually get treatments that are proven and effective (Wiler, Pines, & Ward, 2019). According to Strome (2019), this case is particularly true and event rampant to the persons that insured, uninsured, or under-insured. The lack of proper coordination of chronic diseases patients' care would only source more or exuberate poor healthcare. The unsurprising healthcare system's underlying fragmentation only fuels the issue given that many health care providers hardly have the payment support such related gears, necessary for effective communication and coordination to improve patient care.
While a significant number of patients miss medically necessary care, other clients get unnecessary or even unsafe attention. Research depicts terrific variations in hospital inpatient lengths of stay, specialists' visits, testing and procedures, and costs — not just by United States' unalike geographic areas, but from one health institution to another in the same town (Wiler, Pines, & Ward, 2019). Though limited, evidence on the most effective treatments and procedures, on the best way of informing providers about the efficacy of different treatments, and on the failures of detecting and reducing errors further underwrite the gaps care's quality and effectiveness (Strome, 2019). The concerns are especially pertinent to the Americans of the lower social classes as well as to those from diverse demographic and ethnic groups are usually frequent victims of a lot of incongruences in health and health care.
The implication of Poor Patient Care
Poor quality care impacts both patients and providers negatively. For patients, it reduces their survival changes, aggravates illnesses, and leads to unnecessary mortalities (Graban, 2018). To providers, such issu.
Running head A REVIEW OF KEY CURRENT HEALTHCARE ISSUES QUALITY A.docxhealdkathaleen
Running head: A REVIEW OF KEY CURRENT HEALTHCARE ISSUES: QUALITY AND VALUE IN THE U.S’S HEALTHCARE SYSTEM 1
A REVIEW OF KEY CURRENT HEALTHCARE ISSUES: QUALITY AND VALUE IN THE U.S’S HEALTHCARE SYSTEM
A Review of Key Current Healthcare Issues: Quality and Value in the U.S's Healthcare System
Student's Name
Institution Affiliation
Date
A Review of Key Current Healthcare Issues: Quality and Value in the U.S's Healthcare System
Healthcare regulations, funds, workload, and technology continue to complicate and inconvenient the U.S healthcare system. However, the quality and value of care tops. In the United States of America, despite significant healthcare transformation efforts, poor care lingers a considerable concern.
America is second to none in terms of healthcare expenditure across the globe. Ironically, evidence shows that its citizens do not receive the most appropriate care, or at least, which they need. For instance, Graban (2018) documents that preventive care is underutilized in the country, which is escalating the budget of managing advanced diseases. On the other hand, patients of chronic ailments such as diabetes, hypertension, and cardiac complications, do not also usually get treatments that are proven and effective (Wiler, Pines, & Ward, 2019). According to Strome (2019), this case is particularly true and event rampant to the persons that insured, uninsured, or under-insured. The lack of proper coordination of chronic diseases patients' care would only source more or exuberate poor healthcare. The unsurprising healthcare system's underlying fragmentation only fuels the issue given that many health care providers hardly have the payment support such related gears, necessary for effective communication and coordination to improve patient care.
While a significant number of patients miss medically necessary care, other clients get unnecessary or even unsafe attention. Research depicts terrific variations in hospital inpatient lengths of stay, specialists' visits, testing and procedures, and costs — not just by United States' unalike geographic areas, but from one health institution to another in the same town (Wiler, Pines, & Ward, 2019). Though limited, evidence on the most effective treatments and procedures, on the best way of informing providers about the efficacy of different treatments, and on the failures of detecting and reducing errors further underwrite the gaps care's quality and effectiveness (Strome, 2019). The concerns are especially pertinent to the Americans of the lower social classes as well as to those from diverse demographic and ethnic groups are usually frequent victims of a lot of incongruences in health and health care.
The implication of Poor Patient Care
Poor quality care impacts both patients and providers negatively. For patients, it reduces their survival changes, aggravates illnesses, and leads to unnecessary mortalities (Graban, 2018). To providers, such issu ...
Safe Patient Care
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This document discusses the need for increased patient safety in the U.S. healthcare system. It notes that medical errors have increased significantly in recent decades. While suggestions have been made to improve policies, procedures, and oversight, leadership within individual organizations will be key to implementing new patient safety protocols. Research is also needed to better understand errors and develop solutions. A focus on leadership, data, education, and continuous improvement can help healthcare organizations strengthen patient safety standards over time.
Whitepaper: Hospital Operations Management reduces wait states and replaces d...GE Software
No Wait States … in pursuit of the frictionless patient experience. Electronic health records have fallen short. Patients continue to wait. Costs remain high. Why focusing on operational management can help hospitals make things right … starting now.
Addressing pediatric medication errors in ED setting utilizing Computerized P...Arete-Zoe, LLC
Pediatric patients who are treated in general acute care hospitals are at increased risk of medication errors. The main reasons are the lack of experience with the special needs of pediatric patients, their lower ability to tolerate medication errors, medication-related problems such as forms and packaging designed primarily for adults and labeling with insufficient information on the dosing of pediatric patients. Medication errors can be reduced significantly by appropriate medication management systems. Computerized Provider Order Entry (CPOE) systems reduce the frequency of medication errors in all stages of the process. IT technology introduces an additional vulnerability in the form of IT-related medication errors. Nurses are the last individuals in the medication management process who can detect and intercept a medication error and prevent incorrect medication orders from reaching and harming their patients. To be able to do so, nurses have to be familiar with the medication management system in their hospital and escalate incorrect orders as appropriate and relevant.
The National Academies Health and Medicine DivisionAbout U.docxdennisa15
The National Academies
Health and Medicine Division
About UsPublicationsActivitiesMeetings
Announcement
Crossing the Quality Chasm: The IOM Health Care Quality Initiative
In 1996, after releasing America's Health in Transition: Protecting and Improving Quality, the IOM launched a concerted, ongoing effort focused on assessing and improving the nation's quality of care.
The first phase of this Quality Initiative documented the serious and pervasive nature of the nation's overall quality problem, concluding that "the burden of harm conveyed by the collective impact of all of our health care quality problems is staggering" (Chassen et al., 1998).
IOM Definition of Quality
The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.
This phase built on an intensive review of the literature conducted by RAND to understand the scope of this issue (Schuster) and a framework was established that defined the nature of the problem as one of overuse, misuse and underuse of health care services (Chassen et al). More specifically, the report Ensuring Quality Cancer Care (1999) documented the wide gulf that exists between ideal cancer care and the reality many Americans with cancer experience.
During the second phase, spanning 1999-2001, the Committee on Quality of Health Care in America, laid out a vision for how the health care system and related policy environment must be radically transformed in order to close the chasm between what we know to be good quality care and what actually exists in practice. The reports released during this phase—To Err is Human: Building a Safer Health System(1999) and Crossing the Quality Chasm: A New Health System for the 21st Century(2001)—stress that reform around the margins is inadequate to address system ills.
The series of IOM quality reports have included a number of metrics that illustrate how wide the quality chasm is and how important it is to close this gulf, between what we know is good quality care and what the norm is in practice.
To Err is Human put the spotlight on how tens of thousands of Americans die each year from medical errors and effectively put the issue of patient safety and quality on the radar screen of public and private policymakers. The Quality Chasm report described broader quality issues and defines six aims—care should be safe, effective, patient-centered, timely, efficient and equitable—and 10 rules for care delivery redesign.
Phase three of the IOM's Quality Initiative focuses on operationalizing the vision of a future health system described in the Quality Chasm report. In addition to the IOM, many others are working to create a more patient responsive 21st century health system, including clinicians/ health care organizations, employers/consumers, foundations/research, government agencies, and quality organizations. This collection of efforts focus reform a.
Barriers to Health Care Access for Low Income Families.docxwrite31
Patient safety issues in healthcare can arise from errors such as misdiagnosis, poor communication between providers, and an overburdened healthcare system. The most common causes of safety lapses are preventable adverse events stemming from diagnostic errors, failures to consider patient context, and miscommunication. Implementing electronic health records and improving communication standards and leadership can help create a culture of safety to reduce errors and protect patients.
Professional Association Membership Paper 2.docxsdfghj21
This document discusses the importance of professional nursing organizations and their role in establishing standards of practice, advocating for legislative changes, and providing continuing education opportunities. It focuses on the American Nurses Association, which began in 1896 in response to concerns about nursing standards and competency. Professional organizations work to support nurses and improve the nursing profession. They are responsible for developing certified nurses and protecting the public through regulatory standards like the National Patient Safety Goals, which were created after a 1999 report found that medical errors resulted in up to 98,000 deaths per year. Professional organizations aim to keep nurses informed of healthcare changes and evidence-based practices through networking and educational events.
Similar to Problem And Description Of Terms For Disseratation (20)
Problem And Description Of Terms For Disseratation
1. Chapter I
Introduction
This research compiled and summarized existing case law, reports, and evidence on
the aspects of medical malpractice as it related to tort law, proximate cause, and
education in the hospital system. Risk associated from the emerged problem was focused
in the medical setting when the physician or clinician performed a negligent medical
treatment which caused harm to the patient. Medical errors caused up to 98,000 people
to die in the United States yearly and fifty eight percent (58%) of these deaths from errors
1
2. may had been preventable. They were the fifth leading cause of death and cost the
United States $29 billion dollars annually (Kohn,1999). An estimated 15 million
incidents of medical harm occurred in the US each year at a rate of over 40,000 people
per day (IHI, 2006). This was a burden larger than most patients, medical professionals,
and even healthcare researchers realized. The healthcare system focused on
improvements in systems but many of the strategies and technology recommended had
not been fully implemented.
The National Patient Safety Foundation (2002), a multidisciplinary group was founded
in 1998, for the purpose of identifying approaches, which when implemented would
improve healthcare practice. They intended to improve patient safety through identified
2
3. approaches which were imperative to the healthcare industry to promote safe healthcare.
The Foundation included increased awareness on patient safety issues through research,
publication, and advocacy. Medical schools needed more emphasis on the educated
efforts in handling errors that occurred in the hospital system . Medical students needed
to learn how to develop rapport with patients and family members when errors occurred.
This was a skill in which many practicing physicians had never dealt with in medical
school. Thus, the lack of experience and training in coping with affected family members
hindered important communication between the patient and physician (Meyer,2001).
Physicians were less likely to be sued if they had established a relationship with the
patient (Levinson, 1997).
The “Leap Frog Group,” an advocacy group founded in 2000, recognized a
3
4. dysfunction in healthcare. They consolidated from a group of large employers to work
together to influence quality and affordability when they purchased healthcare.
Employers were spending billions on healthcare for their employees but had no way to
assess the quality of service rendered. They also had identified strategies that decreased
medical errors and improved patient care and safety. Computerized prescriptions in
hospitals emerged from this, decreasing errors caused by incorrectly reading hand-written
material. Patients who had complex conditions or needed specialized procedures were
sent to hospitals with documented proven outcomes experienced in handling those
procedures or conditions. Properly staffed intensive care units were recognized in
hospitals (ICU’s) with physicians, such as Intensivists, well-trained to care for this
population. These measures were based on credible data that supported these
implemented steps (Leapfrog Group, 2000).
A sentinel event was defined according to The Joint Commission on Accreditation
(JACHO) as an unexpected occurrence that involved death or serious physical or
psychological injury, or the risk thereof. The defined term a risk thereof, included any
process variation for which a recurrence would carry a significant chance of a serious
adverse outcome (ISPM Medication Safety Alert, 2006).
Recent cases that were examined indicated that there was sufficient evidence in the
lack of understanding and education which contributed to the long term consequences
which had impacted staff and the hospital institution. Criminal investigations and felony
indictments were levied against some or all of the practitioners involved in errors under
the theory of respondent superior. Tragic loss of life and these events had adverse effects
on the healthcare system. Critical process improvements and education were propelled to
4
5. the forefront as initiatives for improved safety outcomes for the patient population
(Wisconsin Nurses Association, 2006).
Safety experts and the criminal justice system seemed to be at odds over the proper
course of action of a fatal event. Licensing boards took exception to human errors and
tended to limit or revoke licenses for reckless or incompetent healthcare practice. The
hospital employee could be held responsible for negligence. To avoid acting negligently,
healthcare workers needed to minimize risk through the identification of their internal
policies and the empowerment of education. By implementing standard protocols in the
hospital system, errors were diminished (Diamond 200). Most errors were not due to a
reckless or incompetent employee, but to faulty, complicated structures (Olsen, 2002).
The Institute for Healthcare Improvement (IHI) a not-for-profit organization led the
improvement of health care throughout the world by making needed changes. Founded
in 1991 and based in Cambridge Massachusetts, IHI worked to accelerate change by
cultivating concepts for improved patient care and turning those ideas into actions. The
IHI’s proposed solutions to the problem of sub-standard quality care had included
upgrading quality through process improvement, reporting of system errors, performance
standards, new education, cultural change, and new technology. The IHI initiative for
reduced mortality was the ultimate health care improvement goal as a result of these
proposals. Thousands of hospitals reached new thresholds of safety, and new standards of
care were established as a result (IHI, 2006).
Medical errors were grouped into four categories that affected the patient:
diagnostic, treatment, preventative, and other. Diagnostic errors included errors or a
delay in the actual diagnosis. This type of error would delay proper treatment that the
5
6. patient needed to prevent further complication or even spread of the illness. Studies
comparing diagnoses to postmortem necropsy results indicated that forty percent ( 40%)
to sixty percent (60%) of diagnoses listed in the patients’ charts were incorrect. The
same study indicated that the errors had a significant impact on the patients’ outcomes in
ten percent (10%) of the cases reviewed (Goldberg, 2002).
The effects of medical malpractice suits had far reaching consequences webbed into
the societal structure of the United States. The published information included the
patient, physicians’ practice, the organization or the hospital, and society. This crisis had
negative consequences which impacted care received and the availability of quality of
care. A few reasons were identified why this crisis had impacted so many in the
United States. Physicians had left states associated with high cost insurance premiums
and had left high risk specialty areas such as obstetrics and neurosurgery. Physicians
sometimes withheld their services or refused services, which left other physicians
covering their specialties. Economic cost increased as the cost of medical malpractice
rose. The premiums in a few states rose thirty three percent (33%) which could equate to
$150,000 a year for medical malpractice insurance. Physicians had demanded the right
not to carry insurance coverage and refused to provide after hour services which
placed them in direct violation with state by-laws (Darr, 2004).
Defensive medicine was a consequence of medical malpractice. The term came from
the practice of physicians ordering expensive procedures used to defend physicians
against liability. The unnecessary tests were evident in delays of diagnosis and led to
often more expensive tests that were not necessary. This created an environment that
often carried risk from delays and increased financial costs. Defensive medicine added
6
7. about $50 billion annually to the cost of healthcare in the United States between 2005
and 2006 ( Joyce, 2007).
The American public had been associated to the risk with medical care provided in
the hospitals in the United States. The consumer had become aware through publicized
accounts of errors and medical malpractice in the media. This information emphasized
quality in the hospital system. A poll revealed that 56 percent (56%) of Americans
believed that the healthcare system needed change (Louis Harris and Associates, 2002).
A few U.S Hospitals adopted and implemented various total quality management
(TQM) programs as a result. A quality movement incorporated plan that offered to
accelerate change in the hospital was Six-Sigma, a methodology an extension of the
Failure Mode and Effects Analysis that was required by JACHO. The methodology had
taken TQM to the next level with reduced medical errors and increased
profitability in the hospital system through employee training and a quality philosophy.
The available evidence supported the recommendations that healthcare systems
needed to initiate education to modify or mitigate the risk (Cook, 2004). The lack of
education focused on tort law and the elements, or prima facie case requirements, were
unknown or not fully understood by the medical staff. Risk information provided in case
studies had given examples of consequences that occurred from a particular
medical procedure, and the duty to disclose a risk, which represented the proxy of
court outcomes associated with these events. Negligence occurred in many instances,
such as errors while delivering care to the patient in the hospital system. There were
documented proximate causes associated with errors such as lack of knowledge about a
drug, condition or procedure. Rule violation was also identified as a proximate cause
7
8. which led to negligence such as, not following hospital protocols or standard of care
during procedures. Several other documented causes that satisfied the link in proximate
cause were: faulty interaction, communication and documentation for provided
continuum of care, followed by slips in memory, and staffing ( Al-Assaf,2003).
Negligence contained four elements, or prima facie case requirements, which needed to
be established for liability purposes. The four were: 1.) A duty by the physician which
met the standard of care 2.) Failure to perform that duty 3.) Proximate cause between
defendants’ failure and plaintiffs’ injury, and 4.) The injury in which compensation was
adequate for relief of the injury (Madden, 2000).
Another case for the plaintiff arose when there was an injury caused by the outcome
or procedure and there was no medical consent for that procedure. The error did not
occur in the care given by the physician but in the physician not obtaining medical
consent. Consent had to be given by a patient that had the capacity under the mental
health act to make rational decisions. Age was another factor that contributed when
consent was obtained; adults were classified as eighteen years old and over unless the
patient had been legally emancipated. Consent is a legal defense against assault and
battery cases (Campbell-Tiech, 2003). The prima facie case requirements for this type of
case were as follows: The physician had a duty to disclose particular information to the
patient and the disclosure did not occur. This lack of information about the significant
risk affected the outcome, and the patient would likely have refused the procedure if he
had been apprised of that information. Lastly, the procedure caused the plaintiffs’ injury
which courts treated as a matter of negligence (Madden,2000).
In “failure to warn” cases, juries were empowered to dissect the case presented and
8
9. determine if all the prima facie case requirements were satisfied and determine if the
warning was adequate. Medical Informed Consent law required the disclosure of the
risks and the alternative suggested medical procedures to provide patients with
knowledgeable decisions about their care ( Madden, 2000).
Both the legal system and healthcare system were complex, and the purpose of the legal
system was to ensure the healthcare system functioned in accordance to laws. The
courts primarily ensured that contracts were followed, by resolving disputes, by judging
whether reasonable expectations of performance were met, and by meting out awards and
penalties based on legal decisions (Eddy, 2001).
Legal settlements in medical malpractice did not mandate system changes or root
causes which prevented future errors (Eddy, 2001). Deming (1986) a renowned
philosophy leader in total quality organization systems, identified measures to improve
processes which had been adopted in some hospital organizations. Deming stated that 94
percent (94%) of all errors were related to the system and not an individual employee
(Deming 1986).
Statement of the Problem
This study addressed the following questions and examined the related problems of
malpractice and errors in the hospital system. The questions stemmed from interests and
concerns in the area of patient safety, education, and proximate cause which accelerated
in the last decade. The questions in this study were formatted: 1.) Was there a casual
connection between errors and lack of education? 2.) Were there quantitative
strategies to analyze root causes in order to understand the source of the medical
error? Research identified and emphasized the complexity of the errors stemmed from
9
10. several variables rather than one cause (Plsek, 2005). 3.) Was there a lack of support
through quality of education provided to the healthcare worker in the university setting
and also in their working environment?. 4.) Would education improve healthcare
workers ability to provide quality of care and mitigate the risk associated with negligent
medical treatment?
With regard to pedagogy, observers noted and criticized that during the first few years
memorization skills overcame critical thinking skills (Carraccio, 2002). The emerged
medical malpractice insurance cost and the cost associated with litigation had impacted
financial consequences for both the physician and the hospital organization (Darr, 2004).
The cost associated with medical malpractice impacted health–insurance programs and
society from defensive medical practice. Taxpayer funds for supporting this practice
were reported to be between $28.6 and $47.5 billion per year ( Joyce, 2007).
The healthcare industry had always sought ways to provide improvements in
healthcare design and re-engineering. Increased complexities emerged out of tort
law formed the basis for physician liability. The lack of understanding and education by
healthcare workers was a focal point of interest for this research study. Hospitals and
medical organizations needed focused management approaches to identify and reduce
risk. Policies and procedures needed to be developed to promote best practice standards
to set a clear vision for provided quality healthcare to the community. Healthcare
workers needed an understanding of the legal elements through formal programs
established in universities and hospital based risk management programs.
The null hypotheses for the quantitative analysis were as follows:
1. There was no significant difference in casual connection between hospital errors
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11. and lack of provided education to the healthcare worker.
2. There was no significant difference in the quantitative strategies utilized in the
healthcare system and the number of errors that occurred in the hospital.
The Purpose of the Study
The Healthcare and medical professionals faced malpractice issues and liability
problems. This study investigated the lack of education and understanding in the area of
tort law and liability. Education was introduced through instruction within defined areas
of tort law which improved the understanding of negligence and, more specifically, the
reduction of medical errors in the hospital system. Constant improvement measures in
risk discipline and education in the university settings needed to be delivered in a subject
format. The education formulated awareness and the understanding of the prima facie
case requirements for the intentional torts and how the laws were applied in the medical
setting.
A change in education was yet another solution with a developed six-sigma model that
was highly rated by individuals which introduced learning by instructional video. This
provided a culture of safety and education quality when new technology for patient care
was initiated in the hospital system (Cook, 2004).
Significance of the Problem
The study produced evidence that there was a correlation of increased medical liability
and the healthcare workers’ lack of education. There was a significant amount of
11
12. documented accounts of liability and the determent errors had on the medical community
and patients. Medical errors accounted for more than 98,000 deaths in the United States
yearly, and approximately 58 percent (58%) of those deaths had been preventable (Kohn,
2001). Millions of dollars related to damages contributed to increased medical
malpractice insurance premiums that compromised care in specialty areas in some states
(McElhatton, 2004). Even with tort reform in most of the states, the medical malpractice
economic solutions had not identified the root cause of errors to prevent further potential
fatal errors in the future (Darr,2004).
Education in this area was not mandated or even presented as a course or possible
solution in the universities where the medical community were trained. Continued
education and training programs which involved risk management not only established
patient safety, but also reduced malpractice lawsuits. Interdisciplinary training had
proven to strengthen teams and reduce errors (Cook, 2004).
The contribution of the study provided a greater depth of knowledge about this
previously studied phenomenon, changed prevailing beliefs and education requirements,
and extended a research methodology for reducing errors.
Delimitations
This study was limited to the demographic area of the medical community in the
Midwestern states from the surrounding hospitals and medical universities. Finally, the
observation phase of the study was not expanded to all the geographical area, due to the
time and monetary constraint of the study.
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13. Limitations
The study was limited to a small geographical region in the Midwest. Subjects in the
study were not culturally diverse. The study pool was small limiting needed experience
with errors that occurred in the hospital system. Most university education in this area
did not emphasize hospital law or tort law in its content to prepare students. In addition,
the data collected from the surveys was not independent to state law which varies from
state to state and was noted in the context of answers. Graduates of medical and nursing
schools obtained their education from a variety of universities, including trade schools as
well as teaching universities. Another factor, which could impact the study was the
reported case studies were not independent only to the demographic area studied in the
Midwest states, but also included Florida and California.
Assumptions
The assumption was made that the available data from the case studies provided a vast
array of topic information on medical errors. Another assumption was that the research
could be easily replicated and justified by another researcher. It was assumed there was a
direct correlation between education of medical personnel and medical liability. Finally,
it was assumed that costs of medical malpractice insurance increased due to increasing
costs associated with medical malpractice claims affected by the civil penalties opposed
by the proxy of the court
Definition of Terms
1. Assault, according to Madden was an intentional tort. The defendant must desire or
13
14. be substantially certain that the actions caused the apprehension of immediate
harmful or offensive contact.
2. Battery, according to Madden was an intentional tort. The defendant acted
Intentionally to cause harmful or offensive contact with a victim’s person.
3. Consent, was a legal condition whereby a person could be said to have given consent
based upon an appreciation and understanding of the facts, implication and future
consequences of an action. In order to give consent, the individual concerned had
adequate reasoning faculties and be in possession of all relevant facts at the
time consent was given. Impairments to reasoning and judgment which would make it
impossible for someone to give informed consent included such factors as severe
mental retardation, severe mental illness, intoxication, severe sleep deprivation,
Alzheimer’s disease, or being in a coma.
4. False Imprisonment, according to Madden, was an intentional tort. The defendant
unlawfully acted to intentionally cause confinement or restraint of the victim within a
bounded area.
5. Emancipation, according to Gifis, was the freeing of someone from the control of
another, such as a parent.
6. Intensivists, were physicians who had training in critical care medicine. The specialty
required additional fellowship training in critical care medicine after their
primary training in internal medicine, anesthesiology, or surgery was completed.
7. Malpractice was a type of negligence in which the misfeasance, malfeasance or
nonfeasance of a professional, under a duty to act, failed to follow generally accepted
professional standards, and that breach of duty was the proximate cause of injury to a
14
15. plaintiff who suffered damages.
8. Proxy, according to Gifis, was an individual or court who was the recipient of a grant
of authority to act or speak for another.
9. Negligence was a duty of defendant the physician to meet the standard of care, failure
to perform that duty, casual connection between defendants’ failure and plaintiffs’
injury, and the injury in fact, one in which compensation was adequate for relief.
10. Policy, referred to the process and achieve rational outcomes.
11. Prima facie was used in modern legal English to signify that on first examination,
a matter appeared to be self-evident from the facts. In common law jurisdictions,
prima facie denoted evidence that, unless rebutted, would be sufficient to prove a
particular proposition or fact. Most legal proceedings required a prima facie case to
exist, following which proceedings then commenced to test it, and created a ruling.
12. Process improvement, was a series of actions taken to identify, analyze and improve
existing processes within a organization to meet new goals and objectives. These
actions often followed a specific methodology or strategy to create successful results.
13. Protocols were medical guidelines for medical treatment. It usually included a
treatment plan and summarized consensus statements and addressed practical issues.
14. Proximate cause was a primary or moving cause of continuous sequence which
produced the injury.
15. Respondent superior was a legal doctrine which stated that, in many circumstances,
an employer was responsible for the actions of employees performed within the course
of their employment. This rule was also called the “Master-Servant Rule”.
16. Six-Sigma was a business management strategy, originally developed by Motorola,
15
16. that today enjoyed wide-spread application in many sectors of industry. It sought to
identify and remove the cause of defects and errors in manufacturing and
business practices. It used a set of quality management methods, including statistical
methods, and created a special infrastructure of people within the organization who
were experts in the method. Each Six-Sigma project carried out within the
organization followed a defined sequence of steps and had quantified financial targets
(cost reduction or profit increase).
17. Tort Law was the name given to a body of law that created, and provided remedies
for civil wrongs that did not arise out of contractual duties. Torts covered intentional
acts and accidents.
18. Vicarious Liability, was a form of strict, secondary liability that fell under common
law doctrine of agency- respondent superior-the responsibility of the superior for the
acts of their subordinate or in a broader sense, the responsibility of any third party that
had the right, ability, or duty to control the activities of a violator.
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