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    How Not To Err in The Er!!!: What Does It Take To Be Good at Something in Which Failure Is So Easy, So Effortless?

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    aman
    Emergency rooms are prone to errors due to factors like disrupted sleep cycles, multiple interruptions, acute time constraints, and crowding. Common types of errors include diagnostic errors, communication errors, pharmacotherapy errors, and documentation errors. To reduce errors, emergency rooms should implement standardized record keeping, written instructions, multidisciplinary communication protocols, medication reconciliation processes, and staff training. Attention to triage accuracy, diagnostic skills, teamwork, and documentation practices can help minimize risks in high-pressure emergency care.

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    How Not To Err in The Er!!!: What Does It Take To Be Good at Something in Which Failure Is So Easy, So Effortless?

    Uploaded by

    aman
    22 views8 pages
    Emergency rooms are prone to errors due to factors like disrupted sleep cycles, multiple interruptions, acute time constraints, and crowding. Common types of errors include diagnostic errors, communication errors, pharmacotherapy errors, and documentation errors. To reduce errors, emergency rooms should implement standardized record keeping, written instructions, multidisciplinary communication protocols, medication reconciliation processes, and staff training. Attention to triage accuracy, diagnostic skills, teamwork, and documentation practices can help minimize risks in high-pressure emergency care.

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    How not to Err in ER!!

    Original Title

    Errors in ER

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    Emergency rooms are prone to errors due to factors like disrupted sleep cycles, multiple interruptions, acute time constraints, and crowding. Common types of errors include diagnostic errors, communication errors, pharmacotherapy errors, and documentation errors. To reduce errors, emergency rooms should implement standardized record keeping, written instructions, multidisciplinary communication protocols, medication reconciliation processes, and staff training. Attention to triage accuracy, diagnostic skills, teamwork, and documentation practices can help minimize risks in high-pressure emergency care.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    22 views8 pages

    How Not To Err in The Er!!!: What Does It Take To Be Good at Something in Which Failure Is So Easy, So Effortless?

    Uploaded by

    aman
    Emergency rooms are prone to errors due to factors like disrupted sleep cycles, multiple interruptions, acute time constraints, and crowding. Common types of errors include diagnostic errors, communication errors, pharmacotherapy errors, and documentation errors. To reduce errors, emergency rooms should implement standardized record keeping, written instructions, multidisciplinary communication protocols, medication reconciliation processes, and staff training. Attention to triage accuracy, diagnostic skills, teamwork, and documentation practices can help minimize risks in high-pressure emergency care.

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    © All Rights Reserved
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    Download as pptx, pdf, or txt
    of 8

    HOW NOT TO ERR IN THE ER!!!

    What does it take to be good at something in


    which failure is so easy, so effortless?

    Dr. Amandeep Singh


    P D Hinduja National Hospital & MRC
    Mumbai
    To Err is Human!
    • Emergency medicine is characterized by the
    simultaneous care of multiple patients with a
    wide variety of conditions, a substantial
    Diagnostic
    proportion of whom are acutely ill. Pharmacotherapy
    • Emergency care providers often have to work in
    Documentation
    conditions involving disrupted sleep cycles,Administration
    multiple interruptions, acute time constraints,
    Communication
    Environmental
    and crowding and must institute major medical
    Others
    interventions for patients according to limited
    historical and diagnostic information
    James F. et al. Annals of Emergency medicine. 2003. Vol 42.
    KEY TO EFFICIENT
    OPERATION OF ER TRIAGE TRIAGE IS WHERE THE DUTY
    TO THE PATIENT BEGINS

    • Dangers of the triage include not only delays in the recognition of life
    threatening illnesses, but inappropriately allowing patients to leave
    prior to treatment.
    • To examine the triage accuracy and exploring the influencing factors.
     Chen et al.(2010). Multicentric crossectional study- Triage accuracy=
    56.2%,
     Olofsson et al.2009. Multicentric crossectional study- Triage accuracy =
    73%,
     Hinson et al. 2018. Single centre retrospective study- Triage accuracy=
    82.9 %

    • ERRORS:
     Triage training, Work experience, Confidence level, Patient history
    DIAGNOSTIC ERRORS(22%)
    • Knowledge,Clinical skills, Experience & Mental
    status and alertness at duty hours.
    • Errors are most common in patients with minor
    trauma and neurological emergencies
    • Nicole M. Dubosh et al.(2015); neurological
    emergencies:Knowledge gap (45.2%), Cognitive
    error(29%), system based error(25.8%)
    • Pieter JM et al. 2017; minor trauma: Primary
    missed diagnosis & failure to correctly interpret
    investigations.
    COMMUNICATION(12%)

    PATIENT
    History taking
    reassurance

    TEAM
    REFFERAL
    Instructions
    Appropriate
    Behaviour
    Detailed
    Handover
    Communication errors: Proposed solutions:
    • Inadequate tranfer of medical
    information • Standardisation of medical
    record keeping, via an
    • Discrepancy between
    information given to doctors electronic system
    and nurses • To document instructions
    • Interpersonel parameter related to medications, tests
    • Lack of focus on empathy and and treatments in written
    rapport form
    • Barriers across different • All communications between
    clinicians’ disciplines and level disciplines should be
    of seniority documented.
    • Contextual factors: Time • Building trust with patients
    pressures, high patient load and
    expectations, Staff shortage • To increase manpower/ staff.
    PHARMACOTHERAPY ERRORS(~16%)
    • Incomplete and inaccurate • Medication reconciliation: 5
    medication histories steps:
    • Inappropriate medication  Obtain a list of current
    ordered medications
    • Incorrect dose ordered  Determine a list of medications
    • Prescription incorrectly to be prescribed
    written  Compare the two lists
    • Order carried out incorrectly  Make clinical decisions
    • Medication incorrectly stored  Communicate the new list to
    in ED appropriate caregivers and the
    patient.
    Most errors occur at
    Junctions of care- Know drug allergies
    at time of admission/ Note adverse drug reactions
    transfer/ discharge
    DOCUMENTATION(~13%)
    • Documentation of patient care information in a
    concise, legible, and accurate manner that
    facilitates quality care and coding
    • Documenting in wrong patient’s chart, Inaccurate
    charting, Incomplete charting

    • Perform administrative procedures for patient


    registration, admission, and discharge; retrieve,
    maintain, and generate patient records accurately
    and efficiently

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