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Medical resident's errors caused by teamwork breakdowns
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Physicians-in-training are highly vulnerable to making medical errors that stem from teamwork breakdowns, especially a lack of supervision by experienced staff, according to a new study funded by the Department of Health & Human Services' (HHS) Agency for Healthcare Research and Quality (AHRQ). Teamwork breakdowns involving medical residents, fellows and interns (first-year residents) also caused a significant number of errors to occur during patient handoffs, researchers found. The study, "Medical Errors Involving Trainees: A Study of Closed Malpractice Claims from 5 Insurers," appears in the October 22, 2007, issue of the Archives of Internal Medicine.

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Researchers at the Michael E. DeBakey Veterans Affairs Medical Center, the Baylor College of Medicine, the University of Texas Medical School at Houston, and the Harvard School of Public Health analyzed data from a random sample of 889 closed malpractice claims which had been reviewed by specialist physicians between 2002 and 2004. The reviewers had determined whether injuries had occurred, and, if so, whether they were due to errors involving medical trainees. The study focused on four clinical categories: obstetrics, surgical, missed and delayed diagnoses, and medications. Collectively, these four categories cover approximately 80 percent of all U.S. medical malpractice claims.

Of the closed medical claims involving both error and injury, more than one-fourth (27 percent), or 240 cases, involved trainees whose role in the error was considered to be at least moderately important, the study found. Medical residents were involved in 87 percent of those cases; interns and fellows each were participants in 13 percent. Adverse outcomes were serious: one-third resulted in significant physical injury, one-fifth in major physical injury, and one-third resulted in death. Nearly a third of the cases took place in the outpatient setting.

"We are continuing to learn about the critical role that effective teamwork plays in preventing medical errors and promoting patient safety," said AHRQ Director Carolyn M. Clancy, M.D. "This study reminds us that we have a lot to do to ensure that hospitals are providing appropriate supervision to trainees and implementing team-training programs, both in the inpatient and outpatient.

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