All Things Medical. Sheldon Cohen M.D. FACP
ALL THINGS
MEDICAL
SHELDON COHEN M.D. FACP
Copyright 2013 Sheldon Cohen M.D. FACP,
All rights reserved.
Published in eBook format by eBookIt.com
ISBN-13: 978-1-4566-2068-4
No part of this book may be reproduced in any form or by any electronic or mechanical means including information storage and retrieval systems, without permission in writing from the author. The only exception is by a reviewer, who may quote short excerpts in a review.
ABOUT THE AUTHOR
A graduate of the University Of Illinois College Of Medicine, the author has practiced internal medicine, served as a medical director of the Alexian Brother’s Medical Center of Northwest Suburban Chicago and as medical director of two managed care organizations: Cigna Health plan of Illinois and Humanicare Plus of Illinois. The author taught internal medicine and physical diagnosis to medical students from Loyola University Stritch School of Medicine and the Chicago Medical School. Recognizing the fact that busy physicians are pressed for time and thus often fail to capture a thorough medical history, the author perfected one of the first computerized medical history systems for private practice and wrote a paper on his experience with 1500 patients who utilized the system. This was one of the early efforts in promoting electronic health records, a work in progress to this day. The author served as a consultant for Joint Commission Resources of the Joint Commission on Accreditation of Healthcare Organizations, did quality consultations at hospitals in the United States, Rio de Janeiro, Brazil, Copenhagen, Denmark, and served as a consultant to the Ministry of Health in Ukraine assisting them in the development of a hospital accrediting body. Dr. Cohen is the author of 25 books.
The information, ideas, and suggestions in this book are not intended as a substitute for professional medical advice. Before following any suggestions contained in this book, you should consult your personal physician. Neither the author nor the publisher shall be liable or responsible for any loss or damage allegedly arising as a consequence of your use or application of any information or suggestions in this book.
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PART 1
THE PREVENTION OF MEDICAL ERRORS
“Es Irrt Der Mensch, So Lang Er Strebt”
(As long as human beings strive, they will make errors)
Johann Wolfgang von Goethe
(1749-1832)
Introduction
A medical error has occurred anytime a healthcare provider plans a medical action and it does not succeed as intended, or the wrong plan is used. These errors can include problems in medical practice, failure to diagnose, procedural problems, system failures, or product deficiencies.
Ninety-eight thousand people per year die from medical errors, a number that represents more deaths than occur from automobile accidents or breast cancer. This statistic, published by the Institute of Medicine in 1999, has prompted efforts by the Joint Commission on Accreditation of Healthcare Organizations to focus the accreditation process on operational systems critical to the safety and quality of patient care.
What is the Institute of Medicine? Who are its members? Are they a governmental organization? What is the funding source?
The federal government created the National Academy of Sciences to serve as an advisor on scientific matters. However, the Academy and its associated organization (e.g. the Institute of Medicine) is a private, non-governmental organization that does not receive direct federal appropriations for their work. The Institute of Medicine’s charter establishes it as an independent body. They use unpaid volunteer experts who author their reports, each of which undergoes a rigorous and formal peer review process that must be evidence-based where possible, or noted as an expert opinion where not possible. Many meetings of the Institute of Medicine are open to the public, or the committee may deliberate amongst themselves until they reach consensus. Any potential conflict of interest could disqualify a committee member.
One cannot dispute this committee’s findings—the best minds are at work. In addition, the Joint Commission considered it serious as well, for they have launched a nationwide effort to minimize medical errors in healthcare organizations.
Let us define what medical errors are. The Joint Commission has categorized a long list of hospital errors that have resulted in death or injury, the so-called sentinel events. This is necessary so that the Joint Commission can investigate and make sure that hospitals have put systems in place to prevent the error from reoccurring. These sentinel events are:
•Anesthesia related: death or injury may result from anesthesia.
•Delay in treatment: failure to diagnose in time, treatment delays resulting in disability or death and wrong diagnoses are all medical errors. An incomplete medical examination is often the reason.
•Elopement: serious injury or death could result when patients leaves facilities of their own accord before diagnosis.
•Infection-related: lapses in sterile technique may result in an infection.
•Maternal deaths: obstetrical deliveries may result in injury or death.
•Medical equipment: medical equipment failures may result in disability or death.
•Medication error: physician, pharmacist, or patient error may result in injury or death due to improper or wrong medication use.
•Operative/post-operative: complications may result from surgical or post surgical care.
•Patient abduction: infant abduction from newborn nurseries have occurred.
•Patient falls: the failure to identify the fall-risk patient, and/or the failure to safeguard the patient may have serious consequences.
•Perinatal deaths/injury:injuries or death may occur around the time of birth.
•Potassium Chloride: the accidental direct intravenous injection of potassium chloride can result in cardiac