Research suggests that medical errors are the third leading cause of death in the United States, pushing hospitals to rethink their approach to patient care. This situation means many healthcare organizations are busy planning and launching new initiatives to combat adverse patient outcomes. However, it is important to consider at what point these initiatives intervene in the cascade of actions that may lead to errors. Equipping your care providers with a quality residency program at the start of their careers is one way to prevent that unfortunate combination of actions from even beginning, reducing potential adverse patient outcomes. In a recent conversation, Kimberly Sulger, HealthStream’s AVP of Clinical Solution Success Management, shares her perspective on why mistakes are so easily made and how hospital onboarding programs play a vital role in reducing errors.
What Qualifies as an Adverse Patient Outcome?
HHS refers to adverse events as “harm from medical care rather than an underlying disease.” Adverse events may or may not be preventable, and there are several subcategories of adverse patient outcomes, including preventable adverse events, ameliorable adverse events, and adverse events due to negligence (AHRQ, 2019).
HHS explains a near miss as “an unsafe situation that is indistinguishable from a preventable adverse event, except for the outcome. A patient is exposed to a hazardous situation, but does not experience harm either through luck or early detection.” An error is defined as “an act of commission (doing something wrong) or omission (failing to do the right thing) leading to an undesirable outcome or significant potential for such an outcome” (AHRQ, 2019).
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