Study looks at in-office errors by family physicians

Doctors have differing ideas of "patient harm."

By Andis Robeznieks — Posted April 12, 2004

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Patient safety isn't just for hospitals anymore. That's the message of Nancy Elder, MD, at the University of Cincinnati's Dept. of Family Medicine. Her recent study on medical errors by family physicians found that errors or preventable adverse events occur in almost one-quarter of all patient visits, and almost one-quarter of these incidents lead to patient harm.

Dr. Elder's study, published in the March/April Annals of Family Medicine, examined 351 patient visits to 15 family physicians at seven offices in urban, suburban and rural settings in the Cincinnati area.

Although the sample size was small, she said the study is important because there is still so little published research regarding medical errors in the primary care setting.

"It was very imperfect, but it's a first guesstimate about how common are these process and latent errors in the doctor's office," Dr. Elder said.

She added that interviewing each doctor about each error led to the discovery that physicians do not have a common understanding of what constitutes "patient harm."

"We talked to 15 different doctors and got 15 different definitions," she said. "So we said this is something we clearly need to understand better."

Examples of harm included physical discomfort, a mild adverse drug reaction, moderate physical injury and progression of disease. The most frequent examples, however, were causing the patient increased emotional distress and wasting the patient's time, although not all physicians felt these met the definition.

"Defining harm can be difficult," Dr. Elder said. "Some things are black and white. Dead patient: Harm. Cut off wrong leg: Harm. But how bad does it have to be?"

In 351 patient visits studied, 117 errors or preventable adverse events occurred. One error happened in each of 61 visits while two or more occurred during 22 visits.

Out of these 83 visits, doctors responded to questions about 76 of them and found that harm occurred for 18 patients and the potential for harm was present for 53 patients. "They say: 'This time it didn't cause any harm because we caught it,' or 'The patient called back,' or fill in the blank, but if that hadn't happened, there could have been harm," Dr. Elder said.

She attributed many errors to a lack of uniform systems at group practices, even though many doctors had individual systems for tracking patient data. "Dr. Jones may have her own system, but what happens when she goes on vacation?"

Dr. Elder added that doctors were surprised when confronted with the number of errors and by other statistics regarding their daily practices -- including a physician who discovered that up to eight interruptions can occur during a patient visit.

Awareness of patient safety is rising, and many family physicians are participating in research studies themselves. Once the preliminary work identifying errors and where they occur is completed, researchers can look for ways to prevent them.

"That's really where we're starting to head," Dr. Elder said. "We're trying to figure out best practices and how to put them in as interventions."

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Primary error

Researchers at the University of Cincinnati recorded and classified the 117 medical errors or preventable adverse events that occurred during 351 patient visits.

Classification Examples Number of
Charting Chart missing or lacking information 37
Physician-related errors Time management or skill problems 28
Office administration Staffing problems, lab or x-ray processing errors 21
Communication errors Appointment and triage errors 16
Preventable adverse events Missed diagnosis, delayed or incorrect treatment 15

Source: Annals of Family Medicine

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External links

"The Identification of Medical Errors by Family Physicians During Outpatient Visits," Annals of Family Medicine, March/April (link)

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