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Identifying patient safety problems during team rounds: an ethnographic study
  1. A Reema Lamba1,
  2. Kelly Linn2,3,
  3. Kathlyn E Fletcher2,4
  1. 1Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas, USA
  2. 2Clement J. Zablocki VAMC, Milwaukee, Wisconsin, USA
  3. 3Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
  4. 4Department of Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
  1. Correspondence to Kathlyn E Fletcher, 5000 W. National Ave., Milwaukee, WI 53295, USA; kfletche{at}

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Triggered by the 1999 Institute of Medicine report, To Err is Human,1 patient safety has become a prominent part of the medicine culture. Hospitals and residency programmes have increased patient safety awareness and education.2–4 In fact, the Accreditation Council for Graduate Medical Education had made explicit its high expectations around quality and safety in the curriculum and the practice environment.5

Many methods exist to identify patient safety issues for quality improvement purposes.6 One study looked at incident reporting, malpractice claims, executive walk rounds, patient complaints and risk management reports to identify areas of overlap7 and found that each had its own strengths and weaknesses. Medical wards may offer additional opportunities to collect safety data and incident reporting. In fact, direct observation of rounds has been used to identify adverse events.8 Therefore, we set out to assess how often patient safety issues occur in daily rounds on medicine wards, what types of issues they are, and how often they are addressed.



An academic veterans affairs medical Centre.

Study design and subjects

This was an observational study conducted between April and June 2012. Inpatient medicine and cardiology team members participated. These teams were chosen because both had inpatient services with similar call schedules. Teams included interns, residents, attending physicians, medical students, pharmacists and pharmacy students. One observer (ARL) conducted all of the observations. In order to optimise reliability, four of the initial observations were done by two observers, and their findings were compared. This allowed subsequent data collection by the single observer to be more open to the insights provided by the secondary reviewers. The primary (ARL) and one secondary observer (KL) had special training through the VA's Chief Resident in Quality and Safety programme.9 This training included a 5-day ‘boot camp’ with sessions that taught advanced quality improvement …

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  • Contributors ARL: concept, data collection, drafting of manuscript. KEF and KL: concept, data collection, critical revision of manuscript.

  • Funding Although this research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors, it was done with support from the Clement J Zablocki Veterans Affairs Medical Centre.

  • Competing interests ARL and KL were VA Chief Residents in Quality and Safety during this work, and KEF was a staff physician at the Clement J Zablocki VAMC.

  • Ethics approval VA IRB.

  • Provenance and peer review Not commissioned; externally peer reviewed.