Team B ( Assignment Oct 3rd )
Definition - A "Medical error" is a preventable adverse effect of care, whether or not it is evident or harmful to the patient. This might include an inaccurate or
incomplete diagnosis or treatment of a disease, injury, syndrome behavior,
infection, or other ailment.
Purpose/Description - Medical errors are the 8th leading cause of death within the United States. Medication error directly results several thousand deaths per year. Medical errors cost the nation 37.6 billion dollars each year. These errors are theoretically preventable, and in turn can improve patient outcomes and adverse events. IOM had four core messages:
Examples of common medical errors include:
1. Misdiagnosis of an illness, failure to diagnose or delay of a diagnosis. This
type of error could be a direct mistake of a doctor or caused when the doctor
is acting on incorrect information supplied by some other person. /
2. Giving the wrong drug or (wrong patient, wrong chemical, wrong dose, wrong
time, wrong route) /
3. Giving two or more drugs that interact unfavorably or cause poisonous
metabolic byproducts /
4. Wrong-site surgery, such as amputating the wrong limb /
5. Retained surgical instruments. In particular, gossypiboma, resulting from a
surgical sponge being left behind inside the patient after surgery /
6. Patients' implementation of drugs and treatments /
7. Transplanting organs of the wrong blood type /
8. Incorrect record-keeping
An example of a system-based improvement in medical errors with medication administration is the introduction of the electronic medication record. Pharmacy is able to track correct dosages, drug-drug interactions, and correct medications. Medication reconciliation appears to have simplified process and prevented duplications upon patients discharge.
Reporting of Errors:
A 2005 study by Wendy Levinson of the University of Toronto showed surgeons
discussing medical errors used the word "error" or "mistake" in only 57 per
cent of disclosure conversations and offered a verbal apology only 47 per
cent of the time.
A survey of more than 10,000 physicians in the United States came to the
results that, on the question "Are there times when it's acceptable to cover
up or avoid revealing a mistake if that mistake would not cause harm to the
patient?", 19% answered yes, 60% answered no and 21% answered it depends.
Conclusion:
Medical errors commonly occur in everyday practice and are preventable causes of significant morbidity and mortality. Reporting systems are important to establish to improve accountability and to prevent similar medical errors from recurring. Physicians must improve disclosure of medical errors to the system and patients. Full Disclosure by physicians to patients has also been shown to reduce lawsuits.
ACO – Accountable Care Organization
Definition – A healthcare provider or group of providers that accepts accountability for quality of health care services and the total cost of care received by a population of patients.
Proposed Pathway for Medical Care Payments for an ACO
1. ACOs will have a shared savings/risk for all stakeholders. The fee for service will be either cut or bundled to force savings compared to the full capitation model.
Opinion regarding ACO-
It is a big challenge in achieving total “buy-in” from all stakeholders involved including physicians, hospitals, and patients. It is better than full capitation payment, in which quality outcomes are not determined or assessed.
Within the ACO, determining adequate patient quality outcomes may be challenging. Patient quality outcomes will need to be adjusted according to different patient populations/settings.
Another challenge for an ACO will be to determine a fair system has to be developed for distribution of the savings. Although there can be an overall shared savings to the system, there is an inherent shared risks which will be present for all stakeholders involved until efficient protocols are developed.