Abstract
BackgroundPatient chart review is the gold standard for detection of potential patient hazards (i.e. medication errors or failure to follow up actionable results) in both routine clinical care and patient safety research. However, advanced medical students’ ability to read patient charts and to identify patient hazards is rather poor. We therefore investigated whether it is possible to teach advanced medical students how to identify patient hazards independent of context (i.e. cancer versus cardiac failure) in patient charts.MethodsAll fifth-year medical students in one semester (n = 123) were randomized into two groups. One group (IC) received a patient chart review-training first and then a control-intervention and the other group (CI) received the control-intervention first and then the patient chart review-training. Before and after the teaching sessions, students reviewed different scenarios with standardized fictional patient charts containing 12 common patient hazards. Two blinded raters rated the students’ notes for any patient hazard addressed in the notes using a checklist. The students were blinded to the study question and design. There was no external funding and no harm for the participating students.ResultsA total of 35 data sets had to be excluded because of missing data. Overall, the students identified 17% (IQR 8–29%) of the patient hazards before the training and 56% (IQR 41–66%) of the patient hazards after the training. At the second assessment students identified more patient hazards than at the first. They identified even more in the third. The effect was most pronounced after the patient chart review training (all p<.01).ConclusionPatient chart review exercises and problem-based patient chart review training improve students’ abilities to recognize patient hazards independent of context during patient chart review.
Highlights
Some common patterns constitute a large fraction of patient hazards
Patient chart review is considered to be the gold standard for the identification of many common patient hazards, especially diagnostic problems, medication problems, nosocomial infections and problematic fluid/diet-management [3,4,5,6,7,8,9]
Using a randomized, controlled cross-over-study, we investigated whether a structured problem-based patient chart review training improves the identification of common patient hazards, that is, diagnostic problems, medication problems, inadequate monitoring, and nosocomial infections, independent of context during patient chart reviews by advanced medical students
Summary
Some common patterns constitute a large fraction of patient hazards. According to the data of the National Patient Safety Benchmarking Center, five most frequent medical errors and adverse events (surgical errors, medication errors, medical errors, patient falls, nosocomial infections) account for 67% of medical errors and for 81% of the costs attributable to medical errors [1]. Patient chart review is considered to be the gold standard for the identification of many common patient hazards, especially diagnostic problems (delayed, missed, wrong diagnosis, failure to follow up on actionable test results), medication problems (overmedication, undermedication, wrong dosage, medication contraindications, unauthorized medication, drug-drug interactions), nosocomial infections and problematic fluid/diet-management [3,4,5,6,7,8,9]. In a previous study by our group, 5th year medical students identified only 20% of the patient hazards in fictional patient charts, irrespective of the number of weeks they spent in clerkships in internal medicine [12]. Patient chart review is the gold standard for detection of potential patient hazards (i.e. medication errors or failure to follow up actionable results) in both routine clinical care and patient safety research. We investigated whether it is possible to teach advanced medical students how to identify patient hazards independent of context (i.e. cancer versus cardiac failure) in patient charts
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
