MedicalResearch.com Interview with:
Charlotte Yeh MD FACEP
Chief Medical Officer
AARP Services, Inc
Dr. Charlotte Yeh is the Chief Medical Officer for AARP Services, Inc . In her role, Dr. Yeh works with the independent carriers that make health-related products and services available to AARP members, to identify programs and initiatives that will lead to enhanced care for older adults.
Dr. Yeh has more than 30 years of healthcare experience – as a practitioner and Chief of Emergency Medicine at Newton-Wellesley Hospital and Tufts Medical Center, as the Medical Director for the National Heritage Insurance Company, a Medicare Part B claims contractor, and as the Regional Administrator for the Centers for Medicare and Medicaid Services in Boston.
In this interview, Dr. Yeh comments on the September 2016 AARP Bulletin feature that focuses on twelve common health care blunders and how they can be avoided.
MedicalResearch.com: What is the background for this report? How big is the problem of medical errors?
Dr. Yeh: Medical errors first became widely acknowledged in 1999 with the publication of the landmark study by the National Academy of Sciences (IOM), formerly called the Institute of Medicine (IOM), estimating as many as 98,000 hospital in-patient deaths per year were caused by medical errors. More recently, a study from Johns Hopkins noted that medical errors may claim as many as 251,000 lives per year.
MedicalResearch.com: What are the chief causes of medical mistakes? Are they due primarily to human/system error?
Dr. Yeh: The errors included in these reports cover everything from individual to system errors. And, even the IOM report notes that so many of these errors are compounded by the “system,” rather than the intent of an individual or a “bad performer.” Yes, there are errors due to mistakes by physicians or other clinicians, but many occur because of the complexity of health and a health care delivery system that is not always designed to reduce errors systematically. For example, medication errors can occur when a busy nurse is trying to identify and count the particular pills a patient might need, but is interrupted by calls for nursing assistance. Or the pills have similar names or similar appearances. In this case, the nurse is focusing correctly, but can become distracted by other simultaneous demands or the pills are so similar in name and packaging that they could be confused with others. Many nursing leaders and health systems have recognized that a nurse filling medications for the medication cart should have a quiet place without interruption, along with technology solutions to reduce human error opportunities.
To err is human, but we also can do better to design complex systems to reduce risk of error. To date, putting systematic processes in place has, for example, reduced hospital acquired infections for central lines by 50% since the IOM report came out. Putting in place rigorous hand washing programs, including easier access to a sink with water and soap, can reduce the spread of infections in a health setting, is another example. Checklist procedures have reduced the risk of wrong-side surgery.
MedicalResearch.com: Is there a component of retrospective labeling of an error, ie when the ‘wrong’ antibiotic is chosen for an infection because the sensitivities are not known upon diagnosis?
Dr. Yeh: Yes, there can be errors due to delays, such as delays in diagnosis or change in treatment, because test results are not conveyed timely to the treating physician. Again, these would not necessarily be due to poor physician care, but because the “systems” have not always been set up to identify and inform in real time significant test findings that require action.
MedicalResearch.com: What can be done on a system level to reduce medical errors?
Dr. Yeh: It takes serious commitment from leadership all the way down to every staff member to focus on eliminating errors. It requires the commitment and know-how to do a root cause analysis to identify steps along the way where an error can be prevented, and the willingness to implement the changes. Plus, of course, the resources (time/money/staff) are essential for successful implementation. It’s not easy when you think about the hundreds of interactions with a patient at all levels in a hospital, from orders, to monitors, to tests, to room cleaning, to actual materials used in clothing, bedding and curtains, to patient assistance, to communications, to procedures, checklists and many more. A commitment to systematic review, feedback from staff and patients/families and caregivers, and a culture of continuous improvement rather than a punitive environment, is also necessary.
Finally, it might make sense, given how multifactorial errors and their causes are, to set up a system of reporting similar to the airline safety program. Pilots and airline crew are required to report errors and “near misses,” without fearing reprisal, to allow a safe space to review systematically what went wrong, what corrections can be made, and then disseminated and implemented throughout the field without risk of retribution.
MedicalResearch.com: What can patients do to limit their exposure to medical mistakes?
Dr. Yeh: Patients and families are part of the partnership of care, and essential to help eliminate errors. Most importantly, patients need to speak up! Whether about asking if the staff member washed their hands before examining you, to checking that the medication is the same as you expected, to asking for test results, to asking what you should expect, etc.
The National Patient Safety Foundation recommends the “Ask Me 3”:
1) What is my main problem?
2) What do I need to do? and
3) Why is it important for me to do this?
Any good clinician embraces a patient or family member who speaks up and asks questions when something is not clear, when the information appears inaccurate, or when one simply doesn’t understand. It is often a good idea to have a friend or family member accompany you to any visit, because when you aren’t feeling well, your family member/friend help you remember, ask questions you may have forgotten in the moment, and insist on clarifications and follow-up needed.
And it’s not just about the clinician talking to you…. You (or your friend/family member) know yourself best. Bring the list that includes medications you take, allergies, test results and any known medical conditions you have. Don’t be afraid to say exactly how you are feeling, what you are expecting and any challenges you are facing. Don’t be afraid to ask when something doesn’t make sense to you.
MedicalResearch.com: Is there anything else you would like to add?
Dr. Yeh: Medical errors are important to all of us! As a patient, family or caregiver, you have tremendous insights to provide: Where and what a hospital, office or clinician could do better. Be sure to provide your feedback, participate on patient advisory councils, etc. There are many dedicated leaders and front-line staff who truly believe in elimination of all medical error. Your observations, your questions, your feedback is critical if we are to systematically improve the systems in place, because we all are human.
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Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.
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