Developing and pilot testing practical measures of preanalytic surgical specimen identification defects.

Accurate patient identification is a National Patient Safety Goal. Misidentification of surgical specimens is associated with increased morbidity, mortality, and costs of care. The authors developed 12 practical, process-based, standardized measures of surgical specimen identification defects during the preanalytic phase of pathology testing (from the operating room to the surgical pathology laboratory) that could be used to quantify the occurrence of these defects. The measures (6 container and 6 requisition identification defects) were developed by a panel of physicians, pathologists, nurses, and quality experts. A total of 69 hospitals prospectively collected data over 3 months. Overall, there were identification defects in 2.9% of cases (1780/60 501; 95% confidence interval [CI] = 2.0%-4.4%), 1.2% of containers (1018/81 656; 95% CI = 0.8%-2.0%), and 2.3% of requisitions (1417/61 245; 95% CI = 1.2%-4.6%). Future research is needed to evaluate if hospitals are able to use these measures to assess interventions meant to reduce the frequency of specimen identification defects and improve patient safety.

Improving healthcare quality through organisational peer-to-peer assessment: lessons from the nuclear power industry.

Healthcare has made great efforts to reduce preventable patient harm, from externally driven regulations to internally driven professionalism. Regulation has driven the majority of efforts to date, and has a necessary place in establishing accountability and minimum standards. Yet they need to be coupled with internally driven efforts. Among professional groups, internally-driven efforts that function as communities of learning and change social norms are highly effective tools to improve performance, yet these approaches are underdeveloped in healthcare. Healthcare can learn much from the nuclear power industry. The nuclear power industry formed the Institute of Nuclear Power Operators following the Three Mile Island accident to improve safety. That organization established a peer-to-peer assessment program to cross-share best practices, safety hazards, problems and actions that improved safety and operational performance. This commentary explores how a similar program could be expanded into healthcare. Healthcare needs a structured, clinician-led, industry-wide process to openly review, identify and mitigate hazards, and share best practices that ultimately improve patient safety. A healthcare version of the nuclear power program could supplement regulatory and other strategies currently used to improve quality and patient safety.

Toward improving patient safety through voluntary peer-to-peer assessment.

Health care has primarily used retrospective review approaches to identify and mitigate hazards, with little evidence of measurable and sustained improvements in patient safety. Conversely, the nuclear power industry has used a prospective peer-to-peer (P2P) assessment process grounded in open information exchange and cooperative organizational learning to realize substantial and sustainable improvements in safety. In comparing approaches, it is evident that health care's sluggish progress stems from weaknesses in hazard identification and mitigation and in organizational learning. This article proposes creating and implementing a structured prospective P2P assessment model in health care, similar to that used in the nuclear power industry, to accelerate improvements in patient safety.

Chest radiographic anatomy retention: the impact of preclinical groundwork on clinical recall in two schools.

RATIONALE AND OBJECTIVES: The aim of this study was to verify earlier work on learning and retaining chest radiographic anatomy introduced during preclinical education and revisited in the clinical years by comparing the initial clinical group to clinical students in a second setting who had no preclinical exposure. MATERIALS AND METHODS: One hundred thirty-seven clinical medical students were pretested and posttested on the same 10 items as were used in the first study. Scores on these 10-item standardized pretests and posttests were compared and assessed for statistical significance. RESULTS: Although the clinical students with preclinical exposure scored significantly higher on the pretest than the students without preclinical exposure (mean, 4.42 vs 4.09), there was a much larger significant difference in posttest improvement (mean, 8.65 vs 6.09). Isolating only the senior students to control for clinical experience (pretest, 4.42 vs 4.38; posttest, 8.65 vs 6.09) did not significantly affect outcomes. CONCLUSIONS: Many medical schools are revising curricula and incorporating new models of learning. It may be important to recognize that older approaches such as memorization and testing are still necessary to start building the enormous "filing cabinet" of facts that must be cross-linked, revisited, and retrievable to contribute to a usable fund of medical knowledge.