Elsevier

Clinical Biochemistry

Volume 37, Issue 12, December 2004, Pages 1052-1062
Clinical Biochemistry

Review
Medical errors: impact on clinical laboratories and other critical areas

https://doi.org/10.1016/j.clinbiochem.2004.08.009Get rights and content

Abstract

The Institute of Medicine (IOM) report (1999) stated that the prevalence of medical errors is high in today's health care system. Some specialties in health care are more risky than others. A varying blunder/error rate of 0.1–9.3% in clinical diagnostic laboratories has been reported in the literature. Many of these errors occur in the preanalytical and postanalytical phases of testing. It has been suggested that the errors occurring in clinical diagnostic laboratories are smaller in number than those occurring elsewhere in a hospital setting. However, given the quantum of laboratory tests used in health care, even this small rate may reflect a large number of errors. The surgical specialties, emergency rooms, and intensive care units have been previously identified as areas of risk for patient safety. Though the nature of work in these specialties and their interdependence on clinical diagnostic laboratories presents abundant opportunities for error-generating behavior, many of these errors may be preventable. Appropriate attention to system factors involved in these errors and designing intelligent system approaches may help control and eliminate many of these errors in health care.

Introduction

Patient safety is a current public and health care concern. It has received substantial attention following the release of two recent reports from the Institute of Medicine (IOM) [1], [2]. Both of these reports have placed special emphasis on enhancing patient safety in today's health care system. Much of the problem in the provision of better and safer health care is a result of preventable adverse events due to medical errors [1]. We have previously highlighted some of the key concepts in medical error generation and have suggested a systems approach in medical error reduction [3]. Some specialties in health care are more prone to errors than others. The notability of surgical specialties with respect to the rate of adverse outcomes and errors in surgical practice has been outlined earlier [4]. The Quality of Australian Health Care Study (QAHCS) reported that more than half of all the adverse events recorded in the study were associated with a surgical operation [5]. The Harvard Medical Practice (HMP) Study II identifies certain sites of health care that are high-risk zones for patient safety [4]. In their analysis, the authors suggested that among other sites operating rooms, in-patient rooms, emergency rooms, and intensive care units were high-risk zones. The authors did not clearly delineate the adverse events occurring in the operating rooms and presumably these may be a result of either anesthetic or surgical interventions. However, the authors noted the low preventability of such incidents as compared to events occurring in other high-risk zones, such as emergency departments (EDs) and intensive care units (ICUs), where both preventability and the disability potential due to the adverse events are high [4]. It is these high-risk zones, where preventability of adverse events is high, that are prime areas of concern and are elaborated in greater detail. Apart from the specialties of emergency and intensive care medicine, which are highly interdependent on clinical laboratories, we have also reviewed the impact of errors in clinical diagnostic laboratories.

Section snippets

Clinical diagnostic laboratories

Laboratory reporting has a great influence on clinical decision making. With this high degree of influence, the quality of laboratory testing and reporting is of utmost importance. The IOM report [1] has far reaching implications for all disciplines including pathology activities and laboratory medicine. It is to the credit of the laboratory medicine specialty that the error rates in laboratory activities are far lower than that seen in overall clinical health care [6]. This quality, however,

Errors in emergency medicine

The chaos, the trauma, and the emergencies witnessed in the EDs are like no other in health care. This environment provides abundant opportunities for generating medical errors. The HMP Study II attributed nearly 3% of all adverse events as occurring in the EDs [4]. The IOM report suggested the highest prevalence of medical errors in EDs [1]. More importantly, it has been suggested that emergency medicine is a crucial area for preventable medical errors [33]. This assumes significance when one

Error in intensive care medicine

A majority of general hospitals have fully functioning intensive care units (ICUs). These units are managed by professionals from multiple disciplines and provide care for critically ill patients with life-threatening diseases or injuries. With such a clientele, provision of timely, high-quality care significantly enhances the chances of survival for these critically ill patients. Though ICUs may be further subdivided to cater to a specific subgroup of patients, like surgical ICUs (SICU),

Conclusion

The efforts to reduce medical errors and enhance patient safety can be directed toward many health care processes. Clinical diagnostic laboratories, EDs, and ICUs are recognized risk zones with high potential for error generation. It is prudent that maximum efforts are directed toward preventing errors in areas of high preventability. The human factors involved in generating errors in these specialties deserve priority, and appropriate technology may play a vital role in mitigating many of

Acknowledgments

I would like to thank Drs. K.L. Massey, A. Mulla, and M. Qureshi for their discussion and suggestions in preparing the manuscript. I also thank Heather Neufeld, Ryan Sanders, Ajay Nayar, Todd Reichert, and Mitch Hesson for their useful contributions.

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