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Not sure what to do now that the USPSTF and other organizations have questioned the utility of routine pelvic exams? Many women die each year from preventable cervical cancer, yet doctors aren't urging their younger patients to get vaccinated--possibly to avoid awkward discussions about STDs, an ethicist says. All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC.
Mental health professionals can use different methodologies to conduct a root cause analysis.
This includes putting together a multidisciplinary team trained in qualitative analysis of data. Outcome Bias is a tendency to opt for diagnostic decisions that could lead to a good outcome. Pay attention to a client’s constitutional rights and protect confidentiality and privilege. The following scenarios are presented for your own thinking and discussion with colleagues. Reamer, Frederic G., Social Work Malpractice and Liability, Columbia University Press, 2003. To reduce medical errors for Mental Health Professionals, what are 10 Cognitive Errors related to Diagnosis? While we (and our patients) may view ourselves as doctors, the federal government, state governments and, by extension, most insurance companies do not recognize audiologists as practicing at the same level as medical, dental, or optometric physicians, as the services we provide and the reimbursement we receive for those services require a physician’s referral.
An initiative has been launched to modify that requirement and permit direct referral and reimbursement to audiologists through federal legislation  – the Audiology Patient Choice Act of 2015 (H.R.
Amends title XVIII (Medicare) of the Social Security Act to revise the coverage of audiology services to treat as physicians qualified audiologists authorized by the state and acting within the scope of their licenses to furnish such services.
A recent report from the Institute of Medicine (IOM) has brought the issue of medical errors, once again, to the forefront. IOM’s 2015 report (the full report can be ordered from here) is a continuation of that 1999 call to action as well as another landmark 2001 report  on reshaping the future of American health care for the 21st century. This time, IOM is focused on improving diagnosis in health care, a process that is illustrated in Figure 1. This is an interesting departure from how most of us probably think of diagnostic errors which is the failure to accurately decide on the nature and circumstances of a specific disease or disorder based on the patient’s signs, symptoms, and examination results.  The IOM committee’s definition takes on a more patient-centered view which, being that the patient is the victim of diagnostic errors, seems entirely appropriate and consistent with the prevailing health care trend toward patient-centered care. In reviewing your practice, do you recognize any risks for diagnostic errors reflected in the above list?
Are you communicating the explanation of your patient’s health problems in language that she understands?
Recognizing that much work remains to be done, groups such as the Institute for Healthcare Improvement (IHI) and Mothers Against Medical Error have called for improving the quality and safety of health care and supporting victims of medical harm. Members of the panel following Haskell’s talk will include Julia Mikell, MD, director of quality performance at St. The “triple aim” is one of five key areas of focus for the IHI, an independent, not-for-profit organization concerned with improving health care at local and global levels. Barnett, Buelow, and the College of Health Professions hope that Haskell’s experience will not only raise consciousness about medical errors among Armstrong’s students and the community’s current practitioners, but also highlight the importance of interprofessional communication and collaboration and the role of such teamwork in the delivery of quality care. This has long been a passion for Buelow, who developed interprofessional teamwork opportunities at prior institutions and has spearheaded, along with colleagues, new courses and events at Armstrong over the past eight years. And even though many institutions are moving toward electronic medical records, Streater adds that health care professionals are still learning to use them. Interprofessional teamwork, however, is not new, emphasizes David Ward, PhD, MPA, dean of the College of Health Professions: the notion has been around for decades.
In conjunction with the college’s interprofessional committee, Ward has attempted at Armstrong to address the problem of training health professionals “in isolation” and then “stick[ing] them into the health care environment where we expect them to function as a team and they have never worked with each other before.
Instead, the dean’s priority, Streater explains, is to ensure that interprofessional training and experiences happen as soon as a student declares his or her intention to enter into the health care field—even well before the student has been admitted into a particular degree program.
Barnett adds that interprofessional teamwork also is important because health care “has become increasingly complicated, and the ability for professionals to have structured [and open] communication is most beneficial for the patient. But there are solutions in place, he says, and professionals who can speak from their real-world experiences. Armstrong’s master of health services administration program was the first in the United States to require IHI certification.
Media and HealthThe Center for Public Health Media and Research is dedicated to studying the effects all forms of media have on health and culture and developing effective media-based public health campaigns that promote health in its broadest, most comprehensive sense.
To mark the anniversary of the Institute of Medicine’s watershed report “To Err Is Human: Building a Safer Health System,” West Health is running a series of interviews between their Chief Medical and Science officer Dr.
Joe Smith: Your recent publication on medical errors in the Journal of Patient Safety has achieved widespread notice, leading to medical errors being identified as the third leading cause of death in the United States, though your background is different than many involved in patient safety efforts. John James: I recently retired from a federal agency where I was the chief toxicologist for 25 years. While reading medical literature and looked for root causes, I realized that lethal medical errors are not all that uncommon. JJ: Overall government agencies, including Congress, have not been assertive in addressing the problem of medical errors. CAE Healthcare has set a new standard in female patient simulation with the new Athena female patient simulator by allowing learners to build confidence and competence before treating actual patients.
Take advantage of this opportunity to learn more about this high-fidelity female simulator. Discover for yourself why Athena is the #GoddessofSimulators and why your simulation training program needs her. LEAN Lab Design is a service offered by bioMérieux in partnership with Guidon Performance Solutions. In the bioMérieux-Guidon Lean Lab process, inefficiencies are defined as waste - but not in the traditional sense. Prior to the LEAN laboratory assessment, the microbiology laboratory at CNMC employed 11 FTEs plus a supervisor - and it still does. Pre-LEAN, we were essentially a day-shift laboratory, from 7:30am to 4pm, with almost all of our staff working that shift.
With four FTEs working the evening and night shifts post-LEAN, the laboratory is constantly processing new specimens and examining new cultures.


One of the other major changes resulting from the LEAN Laboratory assessment was better utilization of our laboratory floor space. An unexpected benefit of distributing our workload over 24 hours derived from consolidation of our workstations. As shown in Graph 2, the Molecular Diagnostics laboratory occupied many noncontiguous spaces in the Department of Laboratory Medicine prior to the LEAN redesign. We compared the TATs from identical six month periods: November 2009 to April 2010 (Pre-LEAN) and November 2010 to April 2011 (Post-LEAN). We have seen a significant improvement in TATs for positive cultures from all specimen types, including blood, stool, urine and more. We analyzed the TAT improvements for patients located in our critical care areas, the pediatric and cardiac intensive care units (PICU and CICU), our emergency department (ED), and in our neonatal intensive care unit (NICU). Ultimately, physicians want to make sure they can make the best possible decisions based on their clinical expertise and the symptoms and clues they see in their patients.
Those who practice the profession have the requisite training, license and letters after their names. Enables Medicare beneficiaries to choose a qualified audiologist without regard to any requirement to be under the care of (or referred by) a physician or other health care practitioner, or that services be provided under the supervision of a physician or other health care practitioner.
But with that title comes solemn responsibilities not the least of which is to do no harm, or in the parlance of the day, avoid medical errors. The committee that drafted the current report concluded that, “most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences.
As noted earlier, it is our hearing and vestibular diagnostic-related services that currently define the profession in the eyes of policy makers and insurers. If, however, we want the policy makers and the public to truly view us as doctors, then we, as audiologists, need to assume the responsibilities associated with a doctoring profession and become an active player in the process of reducing diagnostic errors.
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Helen Haskell, the founder of Mothers Against Medical Error, will be the keynote speaker as part of an “Engaging the Patient Experience” panel discussion on Thursday, September 10, at Armstrong State University. The remaining four include ensuring evidence-based practice, creating person- and family-centered care, promoting affordability and sustainability, and improving patient safety.
The IOM defines a medical error as “the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim” (1999, ¶2). In 2000, her fifteen-year-old son died from a “severe medication reaction” following an elective surgical procedure (PVI Staff 2015, ¶5). Not wanting to duplicate what she had done at her previous university, Buelow began at Armstrong by issuing a call for action and says she was surprised by the number of faculty who responded. Rather, it is just that it has not necessarily taken root in most academic settings because programs can easily don “blinders” when they are attempting to meet their own curriculum requirements and accreditation standards.
There is recognition that working across these professions starts with understanding what the professions do. Joe Smith and IOM committee members who helped produce the report (which estimates 440,000 lethal errors each year including hospital acquired infections), as well as other national health experts to examine what progress has been made in reducing medical errors in the US. Do you agree that we need a National Patient Safety Board to better regulate healthcare? James, PhD, former chief toxicologist for a federal agency, who has dedicated his life to patient safety after the loss of his teenage son to medical errors in 2002.
Could you please describe your background and what drove your interest in this important area? I am board certified in toxicology and earned a PhD in pathology in 1981 from the University of Maryland while working at a Baltimore hospital and doing research at the National Cancer Institute. In 2000, the late Barbara Starfield, MD, estimated far more lethal medical errors than in the 1999 IOM report.
In some ways, the Affordable Care Act has addressed some patient safety concerns without changing the fundamental culture that permits errors to continue.
Athena enables healthcare teams to practice a range of clinical skills that will prepare them for real-life situations.
Two years later, the results on workflow, turnaround times (TATS), and patient outcomes have been dramatic. This waste includes over-producing, work-in-process, transport, excess motion, inactivity, errors and rework, and over-processing. But thanks to our increased efficiency, the productivity of our staff has dramatically improved. As a result, the day shift began each morning with a backlog of new specimens and positive blood cultures from the previous night that needed to be processed. Those overtime hours have been markedly reduced by distributing the workload over a 24-hour period. Positive cultures are now identified and worked up during the evening and night shift hours and those results are made available to physicians immediately. By redistributing our staffing to make it possible to process our workload across all three shifts, we made it possible to move automated molecular testing from our day shift-only Molecular Diagnostics laboratory to the Microbiology laboratory.
If growth was insufficient to permit culture workup, the culture media were placed back into the incubator for another 24 hours. Prior to the redesign, our Incoming area was a major laboratory thoroughfare, so you can imagine the chaos created by frequent walk-throughs in an area where our laboratory scientists needed to be very focused.
With fewer staff now working on our day shift, the microbiology laboratory actually needs less bench space since we eliminated two of our four culture plate reading areas. We confirmed that testing performed during these periods was comparable in nature and volume, and came from patients with similar demographics. We’ve gained, on average, a complete day in our positive culture TATs post-LEAN (Table 1). Often, they have to act before they have all the data at their fingertips because their patient is in critical condition.
I know this does not come as news to any of you; as a matter of fact several states require training in the avoidance of medical errors as a requirement for renewal of an audiology license. Abrams has served in various clinical, research, and administrative capacities in the industry, the Department of Veterans Affairs and the Department of Defense. Using estimates from other studies, the IOM’s Quality of Health Care in America Committee concluded that “[a]t 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” (IOM 1999, ¶1). Rich, PhD, associate professor of public health at Armstrong and editor of the Journal of Bioethical Inquiry.


They include “near misses” (where harm does not occur but could have) as well as “minor” and “serious” errors resulting in adverse events—unintended harms caused by the medical care rather than the patient’s illness. Since then, she has engaged in advocacy efforts “to shed a light on the fact that we have professionals [and a profession] with systemic flaws, causing certain things to fall between the cracks,” Barnett explains. A task force was then formed, which later became a college committee, with members meeting on a monthly basis. She is serving as a panelist for the “Engaging the Patient Experience” event because she teaches courses in health communication and has collaborated on research related to medical apology laws.
I also discovered that cardiologists board certified before 1990, such as my son’s lead cardiologist, are certified for life with no requirement to demonstrate continuing competency.
Government officials can be heavily influenced by money originating from medical industry special interests. As such, Athena provides simulation facilitators and their learners with a completely immersive training experience by representing a female patient that possesses feminine features, appropriate proportions and realistic vocalizations. This service involves 3-5 days of observing the lab at its current state – the physical layout and the manner in which samples are processed.
The LEAN Laboratory assessment demonstrated that the microbiology laboratory had marked peaks and valleys of activity, which we needed to level off.
One of the most effective changes made after our LEAN assessment was to convert our microbiology laboratory to a 24-hour operation, Monday through Friday.
There are still mild peaks and valleys of activity, but we have eliminated a great deal of wasted inactivity. This testing is now performed STAT as specimens arrive rather than waiting to be tested in batch mode.
Now, our cultures are examined for the first time after 16 hours of incubation, regardless of the time of day. Post-LEAN, our Incoming area is cellular in nature and is now much closer to our media storage cold room and our incubators, resulting in much less nonproductive walking. By converting our classic virology testing to molecular testing, we eliminated two tissue culture hoods and a tissue culture incubator, freeing up valuable floor space. Now, the Molecular Diagnostics laboratory is more consolidated and has an additional 225 square feet. These time-to-results improvements that we’ve seen across the board from our microbiology lab are vitally important because they confirm when our physicians have made the right empiric decisions and their patients are being treating correctly, or they tell our physicians to change course and treat their patients differently.
Seven years later, following a request to study adverse drug events (ADEs), the IOM further found that “there are at least 1.5 million preventable ADEs that occur in the United States each year”—although noting that “[t]he true number may be much higher” (IOM 2006, ¶2 under “The Unacceptable Costs of Medication Errors). Joey Crosby, PhD, RPh, professor of health services administration at Armstrong, will moderate the discussion.
Barnett and Janet Buelow, PhD, RN, MSN, MPH, who is Armstrong’s IHI faculty adviser and a professor of health services administration, invited Haskell to be the featured speaker for the “Engaging the Patient Experience” event after Buelow heard Haskell’s story at an academic conference. Within one year, the committee had developed a clear agenda, and the following year, faculty members engaged approximately one hundred students from six disciplines to participate in the first course. Three weeks earlier he had been evaluated by cardiologists for five days, primarily as an in-patient after experiencing a non-fatal collapse while running. Furthermore, the Texas Medical Board verifies Continuing Medical Education in only one percent of doctors each year.
The deliverable is a roadmap outlining how the lab can improve processes to reduce waste and improve efficiency, while simultaneously increasing the quality of results and reducing errors. If growth is insufficient for culture workup, the culture media are re-incubated for four hours and checked again. Even more floor space was recovered by instituting twice weekly, instead of once weekly, culture media shipments, enabling us to move refrigerated supplies from no longer needed floor-standing refrigerators to now empty shelves in our cold room. Since the LEAN staffing changes had to be limited to weekdays, we’ve seen no improvement in TAT for specimens collected on Saturdays, and a slight improvement for those collected on Sundays. In the first case, our improved TATs have given us greater confidence that our patients are being cared for appropriately. For facilitation reasons, aspects of the interprofessional course such as lectures and assignments have been carried out online, but during three of its years it also culminated in a day-long case study, with faculty members or university drama students playing the part of patients. After obtaining a complete set of his medical records, I realized that multiple, catastrophic medical errors had been made by his doctors. I also learned that getting doctors, especially cardiologists, to follow evidence-based clinical guidelines is a challenge and that diagnostic errors are common, but often go unrecognized. Very often, 16 hours of incubation is enough time to obtain adequate growth to inoculate identification and antimicrobial susceptibility tests.
His research has focused on treatment efficacy and improved quality of life associated with audiologic intervention.
These included failure to follow a widely published guideline for potassium replacement in patients with heart arrhythmias, failure to make an obvious diagnosis of acquired long-QT syndrome and failure to communicate to him that he should not be running. Doctor-to-doctor and doctor-to-patient communication errors are also common and occurred in my son’s case.
It could be called the National Patient Safety Board, modelled to some extent after the National Transportation Safety Board or Consumer Product Safety Commission.
In our pre-LEAN laboratory, inoculation of identification and susceptibility tests from uncomplicated cultures often occurred 24 - 48 hours after specimen receipt. Not only does this award-winning device free up well-trained lab scientists from the chore of manually streaking culture plates, PREVI Isola has demonstrated that it provides better colony isolation, leading to fewer subculture plates during workups and faster results from identification and antimicrobial susceptibility tests.
He has authored and co-authored several recent papers and book chapters and frequently lectures on post-fitting audiologic rehabilitation, outcome measures, health-related quality of life, and evidence-based audiologic practice.
He was also denied informed consent because he was deceived about the outcome of his cardiac MRI, which had not been properly performed. The goal of such an agency would be to discover, track and analyze medical errors, and where appropriate, enforce changes – all in a completely transparent way. The well-known limitations and secret-keeping of state medical boards and hospital accreditation organizations would become history. Violations of those rights would be as serious as civil rights violations or violations of OSHA standards that put workers in harm’s way.



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