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Failure in Medical Practice: Human Error, System Failure, or Case Severity?

The success rate in medical practice will probably never reach 100%. Success rates depend on many factors. Defining the success rate is both a technical and a philosophical issue. In opposition to the concept of success, medical failure should also be discussed. Its causality is multifactorial and e...

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Autores principales: Roman, Mihai Dan, Fleacă, Sorin Radu, Boicean, Adrian Gheorghe, Mohor, Cosmin Ioan, Morar, Silviu, Dura, Horatiu, Cristian, Adrian Nicolae, Bratu, Dan, Tanasescu, Ciprian, Teodoru, Adrian, Necula, Radu, Russu, Octav
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9778633/
https://www.ncbi.nlm.nih.gov/pubmed/36554018
http://dx.doi.org/10.3390/healthcare10122495
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author Roman, Mihai Dan
Fleacă, Sorin Radu
Boicean, Adrian Gheorghe
Mohor, Cosmin Ioan
Morar, Silviu
Dura, Horatiu
Cristian, Adrian Nicolae
Bratu, Dan
Tanasescu, Ciprian
Teodoru, Adrian
Necula, Radu
Russu, Octav
author_facet Roman, Mihai Dan
Fleacă, Sorin Radu
Boicean, Adrian Gheorghe
Mohor, Cosmin Ioan
Morar, Silviu
Dura, Horatiu
Cristian, Adrian Nicolae
Bratu, Dan
Tanasescu, Ciprian
Teodoru, Adrian
Necula, Radu
Russu, Octav
author_sort Roman, Mihai Dan
collection PubMed
description The success rate in medical practice will probably never reach 100%. Success rates depend on many factors. Defining the success rate is both a technical and a philosophical issue. In opposition to the concept of success, medical failure should also be discussed. Its causality is multifactorial and extremely complex. Its actual rate and its real impact are unknown. In medical practice, failure depends not only on the human factor but also on the medical system and has at its center a very important variable—the patient. To combat errors, capturing, tracking, and analyzing them at an institutional level are important. Barriers such as the fear of consequences or a specific work climate or culture can affect this process. Although important data regarding medical errors and their consequences can be extracted by analyzing patient outcomes or using quality indicators, patient stories (clinical cases) seem to have the greatest impact on our subconscious as medical doctors and nurses and these may generate the corresponding and necessary reactions. Every clinical case has its own story. In this study, three different cases are presented to illustrate how human error, the limits of the system, and the particularities of the patient’s condition (severity of the disease), alone or in combination, may lead to tragic outcomes There is a need to talk openly and in a balanced way about failure, regardless of its cause, to look at things as they are, without hiding the inconvenient truth. The common goal is not to find culprits but to find solutions and create a culture of safety.
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spelling pubmed-97786332022-12-23 Failure in Medical Practice: Human Error, System Failure, or Case Severity? Roman, Mihai Dan Fleacă, Sorin Radu Boicean, Adrian Gheorghe Mohor, Cosmin Ioan Morar, Silviu Dura, Horatiu Cristian, Adrian Nicolae Bratu, Dan Tanasescu, Ciprian Teodoru, Adrian Necula, Radu Russu, Octav Healthcare (Basel) Commentary The success rate in medical practice will probably never reach 100%. Success rates depend on many factors. Defining the success rate is both a technical and a philosophical issue. In opposition to the concept of success, medical failure should also be discussed. Its causality is multifactorial and extremely complex. Its actual rate and its real impact are unknown. In medical practice, failure depends not only on the human factor but also on the medical system and has at its center a very important variable—the patient. To combat errors, capturing, tracking, and analyzing them at an institutional level are important. Barriers such as the fear of consequences or a specific work climate or culture can affect this process. Although important data regarding medical errors and their consequences can be extracted by analyzing patient outcomes or using quality indicators, patient stories (clinical cases) seem to have the greatest impact on our subconscious as medical doctors and nurses and these may generate the corresponding and necessary reactions. Every clinical case has its own story. In this study, three different cases are presented to illustrate how human error, the limits of the system, and the particularities of the patient’s condition (severity of the disease), alone or in combination, may lead to tragic outcomes There is a need to talk openly and in a balanced way about failure, regardless of its cause, to look at things as they are, without hiding the inconvenient truth. The common goal is not to find culprits but to find solutions and create a culture of safety. MDPI 2022-12-09 /pmc/articles/PMC9778633/ /pubmed/36554018 http://dx.doi.org/10.3390/healthcare10122495 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Commentary
Roman, Mihai Dan
Fleacă, Sorin Radu
Boicean, Adrian Gheorghe
Mohor, Cosmin Ioan
Morar, Silviu
Dura, Horatiu
Cristian, Adrian Nicolae
Bratu, Dan
Tanasescu, Ciprian
Teodoru, Adrian
Necula, Radu
Russu, Octav
Failure in Medical Practice: Human Error, System Failure, or Case Severity?
title Failure in Medical Practice: Human Error, System Failure, or Case Severity?
title_full Failure in Medical Practice: Human Error, System Failure, or Case Severity?
title_fullStr Failure in Medical Practice: Human Error, System Failure, or Case Severity?
title_full_unstemmed Failure in Medical Practice: Human Error, System Failure, or Case Severity?
title_short Failure in Medical Practice: Human Error, System Failure, or Case Severity?
title_sort failure in medical practice: human error, system failure, or case severity?
topic Commentary
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9778633/
https://www.ncbi.nlm.nih.gov/pubmed/36554018
http://dx.doi.org/10.3390/healthcare10122495
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