Shah Rahul K, Kentala Erna, Healy Gerald B, Roberson David W
Department of Otolaryngology, Tufts University School of Medicine, Boston, MA, USA.
Laryngoscope. 2004 Aug;114(8):1322-35. doi: 10.1097/00005537-200408000-00003.
To develop a preliminary classification system for errors in otolaryngology.
A retrospective, anonymous survey was distributed to 2,500 members of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). Respondents were asked whether an error had occurred in their practice in the last 6 months, and if so, to describe the error, its consequences, and any corrective action taken.
There were 466 (18.6%) responses. Two hundred ten (45% of respondents) otolaryngologists reported 216 errors. A classification system for errors in otolaryngology was developed. Errors were classified as related to history and physical (1.4%), differential or final diagnosis (1.4%), testing (10.4%), surgical planning (9.9%), wrong-site surgery (6.1%), anesthesia-related (3.3%), wrong drug/dilution on the surgical field (3.8%), technical (19.3%), retained foreign body (0.9%), equipment-related (9.4%), postoperative care (8.5%), medical management (13.7%), nursing/ancillary (0.5%), administrative (6.6%), communication (3.8%), and miscellaneous (0.9%). There were 78 cases of major morbidity and 9 deaths. If these data are representative, there may be more than 2,600 episodes of major morbidity and more than 165 deaths related to medical error in otolaryngology patients annually.
Human error in otolaryngology occurs in all practice components, including diagnostic, treatment, surgical, communication, and administrative. Types of errors reported by otolaryngologists differ from those reported by other specialists. Error classification systems may need to reflect each specialty's realm of practice. Errors in otolaryngology cause appreciable morbidity and mortality. Quantitative study of errors and the development of targeted prevention and amelioration strategies should be a high priority.
制定耳鼻咽喉科差错的初步分类系统。
向美国耳鼻咽喉 - 头颈外科学会（AAO - HNS）的2500名成员发放了一份回顾性匿名调查问卷。询问受访者在过去6个月的临床实践中是否发生过差错，如果发生过，请描述差错情况、其后果以及采取的任何纠正措施。
共收到466份回复（回复率为18.6%）。210名（占回复者的45%）耳鼻咽喉科医生报告了216起差错。制定了耳鼻咽喉科差错的分类系统。差错分类如下：与病史和体格检查相关（1.4%）、鉴别诊断或最终诊断相关（1.4%）、检查相关（10.4%）、手术规划相关（9.9%）、手术部位错误（6.1%）、麻醉相关（3.3%）、手术区域药物/稀释错误（3.8%）、技术相关（19.3%）、异物残留（0.9%）、设备相关（9.4%）、术后护理相关（8.5%）、医疗管理相关（13.7%）、护理/辅助相关（0.5%）、行政相关（6.6%）、沟通相关（3.8%）以及其他（0.9%）。有78例出现严重并发症，9例死亡。如果这些数据具有代表性，那么每年耳鼻咽喉科患者中可能有超过2600例严重并发症事件以及超过165例与医疗差错相关的死亡。
耳鼻咽喉科的人为差错存在于所有临床实践环节，包括诊断、治疗、手术、沟通和行政等方面。耳鼻咽喉科医生报告的差错类型与其他专科医生报告的不同。差错分类系统可能需要反映每个专科的实践领域。耳鼻咽喉科的差错会导致明显的发病率和死亡率。对差错进行定量研究以及制定有针对性的预防和改善策略应成为高度优先事项。
