Browsing by Subject "Medical Errors"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Errors in completion of referrals among older urban adults in ambulatory care
    (Wiley Blackwell (Blackwell Publishing), 2010-02) Weiner, Michael; Perkins, Anthony J.; Callahan, Christopher M.; Department of Medicine, IU School of Medicine
    RATIONALE, AIMS AND OBJECTIVES: Clinical care often requires referrals, but many referrals never result in completed evaluations. We determined the extent to which referral-based consultations were completed in a US medical institution. Factors associated with completion were identified. METHOD: In a cross-sectional analysis, we analysed billing records and electronic and paper-based medical records for patients aged 65 years or older receiving health care between July 2000 and June 2002 in an integrated, urban, tax-supported medical institution on an academic campus. All referrals in ambulatory care, scheduling of consultation within 180 days, and completion were assessed. We conducted a multivariate survival analysis to identify factors associated with completion. RESULTS: We identified 6785 patients with encounters. Mean age was 72 years, and, of the participants, 66% were women, 55% were African-American and 32% were Medicaid eligible. Of the 81% with at least one primary-care visit in ambulatory care, 63% had at least one referral. About 8% of referrals required multiple orders before an appointment was scheduled. Among 7819 orders for specialty consultation in ambulatory care, 71% led to appointments, and 70% of appointments were kept (completed = 0.71*0.70 or 50%). Scheduling of consultations varied (12% to 90%) by specialty. Medicare, singular orders, location of referral and lack of hospitalization were independently significantly associated with scheduling of appointments. CONCLUSIONS: Among older adults studied, half of medical specialty referrals were not completed. Multiple process errors, including missing information, misguided referrals and faulty communications, likely contribute to these results. Information systems offer important opportunities to improve the referrals process.
  • Thumbnail Image
    Item
    Pilot Study Evaluating a Post Hospital Follow-Up Curriculum for Internal Medicine Interns
    (2023-04-19) Frontera, Eric D; Ho, Monling; Kochhar, Komal
    Objective or purpose of innovation Successful hospital follow-up visits can prevent medication errors and mitigate readmissions. Medical education curricula typically focus on how transitions of care are forwarded to providers within an inpatient setting, or from inpatient to outpatient; however, there is little formal training among Internal Medicine (IM) residents in performing ambulatory hospital follow-up visits. Innovation Design A novel curriculum was created whereby IM interns (PGY1) attended a one hour-long interactive lecture that was offered virtually and in-person. The interns observed patient scenarios that highlighted hospital follow-up tasks, which were then used to create a checklist for the learner to apply to their clinic patients. Evaluation Plan: methods and measures Before and after attending the interactive lecture, the interns were asked to complete a pre-test (n=14) and post-test (n=12) regarding their knowledge and attitudes about hospital follow-up visits. PGY2&3 IM residents (n=26) were also asked to complete the pre-test, but were not asked to attend the interactive lecture. This was done to establish a baseline of clinical competence that might be expected in more experienced residents. Outcomes Chi-square analysis revealed no significant differences between the pre-test and post-test results of the PGY1 interns. In comparison to the more senior residents (PGY2&3), the interns remained significantly less likely (p< 0.05) to be confident in their ability to conduct hospital follow-up visits; to identify ways that hospital follow-up visits can help them understand inpatient care and management strategies; to consider social determinants of health as barriers and as possible triggers for readmission; and to be confident identifying next steps in patient care management following hospital discharge. Innovation’s strengths and limitations Our biggest limitation was the small sample size which may have obscured any impact of the intervention. There are ongoing efforts to replicate this intervention with larger sample size.