Lander Lina I, Connor Jean Anne, Shah Rahul K, Kentala Erna, Healy Gerald B, Roberson David W
Department of Otolaryngology and Communication Disorders, Children's Hospital Boston, and Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts 02111, USA.
Laryngoscope. 2006 Jul;116(7):1114-20. doi: 10.1097/01.mlg.0000224493.81115.57.
The objectives of this study were to describe otolaryngologists' emotional reactions to errors and adverse events, their efforts to take responsibility, and their attempts to implement improvements.
A retrospective, anonymous survey of 2,500 U.S. otolaryngologists who were members of the American Academy of Otolaryngology-Head and Neck Surgery about errors in their practice was conducted. Respondents were asked whether an error had occurred in their practice in the past 6 months and, if so, to describe the error, its consequences, and any corrective actions taken. Two aspects of these reports stood out, which were beyond the scope of the original study: the respondents' emotional responses and their corrective actions.
The response rate was 18.6%. Two hundred ten (45%) respondents reported a total of 212 analyzable error reports and 230 corrective actions. Corrective actions included disclosure to the patient (20 [9%]), ameliorating the consequences of the event to the patient (107 [50%]), personal practice changes (14 [7%]), improvements in the respondent's practice or department (60 [28%]), and hospitalwide or broader corrective actions (19 [9%]). Emotional reactions to errors and adverse events were reported by 22 (10%) otolaryngologists, including regret, embarrassment, guilt, anxiety, loss of temper, and irritation. Legal action was mentioned by five physicians (2%).
Otolaryngologists took actions not only to treat their patients, but also to improve patient care in their practice, department, hospital, or community. Emotional reactions to errors and adverse events are common and need to be addressed in medical training and practice.
本研究的目的是描述耳鼻喉科医生对错误和不良事件的情绪反应、他们承担责任的努力以及他们实施改进措施的尝试。
对2500名美国耳鼻喉科医生进行了一项回顾性、匿名调查，这些医生均为美国耳鼻喉科-头颈外科学会会员，调查内容涉及他们在临床实践中的错误情况。受访者被问及在过去6个月内其临床实践中是否发生过错误，若发生过，则描述错误情况、其后果以及采取的任何纠正措施。这些报告中有两个方面尤为突出，超出了原研究范围：受访者的情绪反应及其纠正措施。
回复率为18.6%。210名（45%）受访者共报告了212份可分析的错误报告及230项纠正措施。纠正措施包括向患者披露情况（20例[9%]）、减轻事件对患者造成的后果（107例[50%]）、个人临床实践改变（14例[7%]）、受访者所在临床实践或科室的改进（60例[28%]）以及全院范围或更广泛的纠正措施（19例[9%]）。22名（10%）耳鼻喉科医生报告了对错误和不良事件的情绪反应，包括后悔、尴尬、内疚、焦虑、发脾气和恼怒。五名医生（2%）提到了法律诉讼。
耳鼻喉科医生不仅采取行动治疗患者，还努力在其临床实践、科室、医院或社区中改善患者护理。对错误和不良事件的情绪反应很常见，需要在医学培训和实践中加以应对。
