MEDICAL ERRORS: Eliminating Fear is Key Factor in Avoiding Mistakes

      To combat the scourge of medical errors afflicting American hospitals, the Department of Veterans Affairs, with 172 medical centers, will hire NASA to perform a three-year, $8.2 million experiment aimed at improving patient safety, the AP/New York Times reports. NASA will establish a system allowing health workers to report medical mistakes without fear of penalty, similar to programs used to improve aviation safety. "If you don't know about it, you can't fix it," Dr. Thomas Garthwaite, the department's acting undersecretary for health, said. Under the program, after health workers report errors, NASA will question them for more details and remove identifying information from its database. The air and space organization will analyze the information and create "safety nets" to prevent similar mistakes in the future. "The idea is to install safeguards against mistakes instead of laying blame," NASA's Dr. James Bagian said (5/31). According to John Eisenberg, director of the Agency for Healthcare Research and Quality, the experiment is a groundbreaking step for the health care industry. "This is a model for the entire health care system," he said, adding, "The VA is way ahead of the private sector" (Davis, USA Today, 5/31).

Private Sector Efforts
      The Los Angeles Times reports that many other hospitals have implemented computerized medical orders that can double check a doctor's treatment orders. Besides eliminating the need for nurses to decipher doctor's notoriously bad handwriting, computer systems can be programmed to question and even refuse certain commands. According to officials at Boston's Brigham and Women's hospital, medical errors at the facility have dropped 55% since switching to a computerized ordering system. Some medical centers also are relying on patient simulators that can mimic various life-threatening conditions to train residents. Stanford University's Dr. David Gaba has designed one such simulator. Residents who work on the simulator later review their performance and discuss ways they could have performed better. In addition to pointing out mistakes, Gaba said that the simulator provides an opportunity to encourage teamwork and leadership during crises. Gaba said, "We are not shooting to make people immune from errors but to make them better prepared to avoid them and to detect them when they occur."

Legal Immunity Needed?
      Despite these technological advances, the private sector's concerns echo those of the VA: to eliminate errors, physicians need to be more candid in reporting mistakes. Pointing to a system that often demands immortal perfection, physicians argue that the fear of malpractice suits discourages them from reporting errors. Dr. James Bagian, director of the National Center for Patient Safety, said, "When you have a culture that stresses the only way to keep patients safe is to be perfect, that's not a good system. You can want to be perfect and strive to be perfect, but when you fall short, the question is, what do you do about it?" That appears to be the million dollar question, as physicians groups, including the American Medical Association, contend that any nationwide error reporting system should be voluntary and provide doctors with some legal immunity. The Association of Trial Lawyers, however, counters that there "is already too much confidentiality in medicine." The group asserts that patients "can learn more about the refrigerator they want to buy than they can about the doctor who is going to cut them open" (Marquis, 5/28).