In this large retrospective cohort of closed claims of medical injury in Japan (of which almost half were deaths and another quarter with long term disability), errors in judgement were found in 3/4 of the cases, and failure of vigilance was found in 2/3. Errors in judgement were almost twice as likely to result in a paid claim compared to other factors. System failures were much less common (teamwork failure in 4% and technology failure in 2%). Although this was a non-US study, we know that cognitive errors are commonly implicated in medical injury cases; systematic buffers to avoid cognitive errors should be built into medical systems, including the routine use of differential diagnoses (for inital and ongoing assessments), use of algorithms/decisions aids/guidelines (in easy to use formats and easy to find places), and use of pre-and post-test probabilities (abstract)
Dr. Scheurer is a clinical hospitalist and the Medical Director of Quality and Safety at the Medical University of South Carolina in Charleston, South Carolina, and is Assistant Professor of Medicine. She is a graduate of the University of Tennessee College of Medicine, completed her residency at Duke University, and completed her Masters in Clinical Research at the Medical University of South Carolina. She also serves as the Web Editor and Physician Advisor for the Society of Hospital Medicine.