Electronic incident reporting and professional monitoring transforms culture

Risk management in IVF

Patient safety incidents occur in approximately 10% of hospital admissions in the UK. Although robust data are not available, assisted conception is unlikely to be any less prone to adverse incidents; indeed there have been several high-profile cases which have drawn attention to this problem. Recently established national reporting systems for adverse events are collecting data which will inform trends in patient safety. Because of the nature of the work undertaken in assisted conception, there is the potential to affect not only future generations but also many patients simultaneously because of storage of biological material. It is therefore important to implement strategies to reduce the likelihood of patient safety incidents. Established methodologies exist for the reactive (root cause analysis) and the proactive assessment of risk (failure mode effects analysis). Furthermore, establishing the detail of a process and its context through process mapping is an important prerequisite for understanding its risk. The knowledge gained through these enquiries enables the implementation of an effective risk management programme which this chapter examines in detail.

Voluntary incident reporting by anaesthetic trainees in an Australian hospital

OBJECTIVE

To assess the reporting of critical incidents by anaesthetic trainees using personal digital assistants. The project also identified the reporting of 'near miss' incidents by anaesthetic trainees.

DESIGN

Comparison of electronic incident reporting with retrospective case note review of cases in which no incident was reported.

SETTING

A 400-bed university teaching hospital in Victoria.

PARTICIPANTS

Fourteen accredited Australian and New Zealand College of Anaesthetists (ANZCA) registrars and their training supervisors.

INTERVENTIONS

Registrars and supervisors underwent initial training for 1 hour and were provided with ongoing support. The cases and incidents reported to the database using the portable digital assistants were analysed.

MAIN OUTCOME MEASURES

These were the total number of anaesthetics reported to the database; the number of incidents reported to the database; the outcome severity of incidents reported; and the number of incidents detected in the case note review that were not reported to the database.

RESULTS

An incident was reported for 156 (3.5%) of 4441 anaesthetic procedures reported to the database. Of these incidents, 72 (46.2%) were 'near misses'. One incident was identified in a review of 208 case notes, which had no incidents reported electronically, and was not reported to the database electronically. This gives a reporting rate of 99.52% [95% confidence interval (CI) 96.9-100%].

CONCLUSIONS

ANZCA trainees in routine anaesthetic practice can reliably use mobile computing technology to report critical incidents and 'near miss' incident data.

Practical virtue ethics: healthcare whistleblowing and portable digital technology

Medical school curricula and postgraduate education programmes expend considerable resources teaching medical ethics. Simultaneously, whistleblowers' agitation continues, at great personal cost, to prompt major intrainstitutional and public inquiries that reveal problems with the application of medical ethics at particular clinical "coalfaces". Virtue ethics, emphasising techniques promoting an agent's character and instructing their conscience, has become a significant mode of discourse in modern medical ethics. Healthcare whistleblowers, whose complaints are reasonable, made in good faith, in the public interest, and not vexatious, we argue, are practising those obligations of professional conscience foundational to virtue based medical ethics. Yet, little extant virtue ethics scholarship seriously considers the theoretical foundations of healthcare whistleblowing. The authors examine whether healthcare whistleblowing should be considered central to any medical ethics emphasising professional virtues and conscience. They consider possible causes for the paucity of professional or academic interest in this area and examine the counterinfluence of a continuing historical tradition of guild mentality professionalism that routinely places relationships with colleagues ahead of patient safety.Finally, it is proposed that a virtue based ethos of medical professionalism, exhibiting transparency and sincerity with regard to achieving uniform quality and safety of health care, may be facilitated by introducing a technological imperative using portable computing devices. Their use by trainees, focused on ethical competence, provides the practical face of virtue ethics in medical education and practice. Indeed, it assists in transforming the professional conscience of whistleblowing into a practical, virtue based culture of self reporting and personal development.

Ethical forces that shape a career in surgery

Our profession is based on ethical behavior, which extends far beyond the rule of law. In this Festschrift for Hiram C. Polk, the ethical forces that shape a career in surgery-including their impact on the timely issue of medical errors, truth-telling, and disclosure-are discussed. The philosophical underpinnings (as addressed by Kant and Aristotle, among others) that may guide the surgeon are considered and discussed with particular emphasis on their relevance to the practice of surgery. The roles that courage, self-evaluation, and teaching play in our practices are reviewed as are new initiatives for improved outcomes for our patients-our ultimate professional goal.