Since To Err is Human was published in 2000, much has been researched and written about the topic of medical errors or adverse events. A key recommendation of that report was the implementation of aggregate reporting systems where data could be compiled and analyzed to provide actionable knowledge about how these events could be prevented. There is debate in the literature about the potential effectiveness of such systems in preventing medical errors and adverse events due to inherent challenges in the voluntary reporting of events. The purpose of this project was to create such a system in a multi-hospital system, together with additional strategies to attempt to reduce the number of adverse events. Key elements of the project included: the system, the data, the analysis, and the feedback. Although it is relatively early in the process, the project is so far proving to be effective.
|Commitee:||Plotkin Olumese, Rachel, Sinay, Tony|
|School:||California State University, Long Beach|
|Department:||Health Care Administration|
|School Location:||United States -- California|
|Source:||MAI 51/05M(E), Masters Abstracts International|
|Subjects:||Nursing, Health care management|
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