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Physician-Reported Adverse Events and Medical Errors in Obstetrics and Gynecology.

Editors

In: Henriksen K, Battles JB, Keyes MA, Grady ML, editors.

Source

Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 1: Assessment). Rockville (MD): Agency for Healthcare Research and Quality; 2008 Aug.
Advances in Patient Safety.

Excerpt

Objective: To explore the feasibility of a novel method for capturing adverse and potential adverse events within an urban teaching hospital obstetrics/gynecology (OB/GYN) service. Methods: At morning rounds during two 6-week periods, OB/GYN resident physicians were asked to complete incident reporting cards identifying obstacles to care, injuries or extended hospitalizations, and problems affecting their patients. Responses were coded by type of incident, consequences for the patient, responsible party, process-of-care deficiencies, and preventability of the incident. These were coded by a physician panel and compared with retrospective chart analysis and hospital incident review. Results: Eighty-two events were reported during the project period, 56 percent in obstetrics and 44 percent in gynecology, including 7 adverse and 38 potential adverse events. Retrospective chart review corroborated 76 percent of the events with only two noted in hospital incident reports. Conclusion: A physician-based voluntary reporting system in OB/GYN complements existing methods for identifying medical errors.

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