Wrong Patients Research Articles

One-year use of the Bloodloc system in an orthopedic institute

Human error in patient or specimen identification due to fatigue, stress and lack of attention by technologists, nurses, interns, and physicians, can cause routinely safety procedures to be circumvented. Clerical errors may occur during the specimen collection, the issue of blood unit and the transfusion of blood. The introduction in an increasing number of hospital of preoperative autologous blood donation programs further increases the chance of error, because a single patient can predeposit multiple units of blood. In this cases there is a greater commitment not only to transfuse any blood unit that is ABO compatible but to transfuse the specific units the patient previously donated for his own use. Human error has been recognized as a significant cause of transfusion-associated fatalities. The persistence of the frequency and type of errors observed in spite of extensive efforts to eradicate them, suggests that errors are inevitable as long as large number of repetitive procedures are performed unless major system changes are adopted. A system (Bloodloc System) that physically prevents the possibility of error was adopted since January 1993 and cuncurrently a quality improvement program (QI) was implemented specifically designed to monitor: 1. the absence of the code on the blood samples, 2. the blood bank error in setting the Bloodloc, 3. the misidentification of blood samples, 4. any attempt to transfuse the wrong blood unit, 5. any attempt to transfuse, the wrong patients. 4895 blood units (2469 autologous and 2426 allogeneic units) were transfused to 1478 patients (849 predeposited an average of 3.3 +/- 2.0 units). The methodological errors (absence of three-letter code on the patient's specimen tube, wrong transcription of the code on the blood sample, wrong setting of the Bloodloc in the blood bank)--41 cases--were limited at the first four months of implementation of the system. In the same period however have been reported 3 potentially fatal errors which have been avoided by the Bloodloc. Two cases of misidentification of blood samples at the moment of the specimen collection, and one attempt to transfuse the wrong units to the wrong patients. The Bloodloc system is effective in preventing potential transfusion-associated fatalities caused by units or recipients misidentification.

Ethics and economic realities. Goals and strategies for care toward the end of life

At the beginning of the 20th century, the American population was primarily made up of children and young adults, and medical care was cheap, generally ineffective, and focused on acute illness. Health care, resource allocation, and priority setting were not issues. In the 1990s and beyond, most medical care will be provided to a growing population of elderly patients with chronic diseases. Neither health care professionals nor health care planners nor economists appear to be able to deal with the now-dominant issue in health policy, ie, the rising costs of, and seemingly insatiable demand for, medical care. At the same time, complex ethical, medical, and economic subplots arise that are forcing a rethinking of the very goals of medicine. Is there provision of too much care, the wrong kind of care (eg, crises-based acute care vs long-term care vs prevention), or care for the wrong patients (ie, the irretrievably ill

Physician's perceptions of the suit-prone patient.

The medical profession is experiencing tremendous increases in the number of malpractice claims and suits. The individual physician is confronted with the question of whether he has patients who are prone to sue him. This paper examines physicians' tendencies to label certain patients as suit-prone and identifies the social characteristics of those labeled as such. The findings suggest that physicians may be labeling the wrong patients. Further, the characterization of the suit-prone patient appears to be a stereotype that merely reflects the physician's political and social attitudes. The moral, ethical, and practical consequences of labeling and of mislabeling are discussed.