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Controversies |

Patient Safety Efforts Should Focus on Medical Errors

Robert A. McNutt, MD; Richard Abrams, MD; David C. Aron, MD, MS; for the Patient Safety Committee
JAMA. 2002;287(15):1997-2001. doi:10.1001/jama.287.15.1997.
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Physicians and other members of the health care team encounter many problems in trying to make medical care safe. Two reports by the Institute of Medicine (IOM) claim that the medical profession is not organized to deliver high-quality care.1,2 While we do not dispute the conclusions in these reports, we believe the reports may underestimate the magnitude of the problem as well as the character. Also, if not carefully considered, the report may lead to taking aim at isolated injuries rather than error. In doing this, the perception may be that medical care is being fixed; instead, the stage is being set for worse errors to come.3 The following case report highlights this issue.

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Figure 1. Classification Scheme for Medical Error
Graphic Jump Location
The sequence of boxes is shown in order of detection, not in order of occurrence.
Figure 2. Model of Constraint in a Health Care Process
Graphic Jump Location
Components within a health care process may occur in an interdependent, nonlinear manner. Each component contributes an amount of output toward achieving safe health care, indicated as units per hour. The overall success of the process is limited by the constraint.

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