TThe Institute of Medicine (IOM) report To Err Is
Human: Building a Safer Health System1
called for voluntary and mandatory reporting systems to identify and learn
from errors in health care. That report and other recent efforts to improve
patient safety have focused their attention on medical errors.2
However, patient safety also may be approached by concentrating on the injury
itself.3,4 Both approaches consider
the subset of patient injuries that are the result of errors (Figure 1). The error-oriented approach includes mistakes that do
not harm patients such as near-misses. The injury-oriented approach includes
patient harm arising from a diagnostic or therapeutic intervention, including
those that are not associated with any identifiable error. The difficulty
in reliably identifying medical errors, the adverse impact on patient outcomes
of medical injuries regardless of whether they result from error, and the
potential preventability of medical injuries not associated with error all
suggest that the injury-oriented approach may be more appropriate and more
productive. This article considers the benefits for patient safety of a primary
focus on medical injury based on the injury prevention model, a public health
approach that has proven useful in addressing other types of injuries.
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