NDLI: Exploring patterns of error in acute care using framework analysis

Content Provider	Springer Nature : BioMed Central
Author	Tallentire, Victoria R Smith, Samantha E Skinner, Janet Cameron, Helen S
Abstract	Background Junior doctors are often the first responders to deteriorating patients in hospital. In the high-stakes and time-pressured context of acute care, the propensity for error is high. This study aimed to identify the main subject areas in which junior doctors’ acute care errors occur, and cross-reference the errors with Reason’s Generic Error Modelling System (GEMS). GEMS categorises errors according to the underlying cognitive processes, and thus provides insight into the causative factors. The overall aim of this study was to identify patterns in junior doctors’ acute care errors in order to enhance understanding and guide the development of educational strategies. Methods This observational study utilised simulated acute care scenarios involving junior doctors dealing with a range of emergencies. Scenarios and the subsequent debriefs were video-recorded. Framework analysis was used to categorise the errors according to eight inductively-developed key subject areas. Subsequently, a multi-dimensional analysis was performed which cross-referenced the key subject areas with an earlier categorisation of the same errors using GEMS. The numbers of errors in each category were used to identify patterns of error. Results Eight key subject areas were identified; hospital systems, prioritisation, treatment, ethical principles, procedural skills, communication, situation awareness and infection control. There was a predominance of rule-based mistakes in relation to the key subject areas of hospital systems, prioritisation, treatment and ethical principles. In contrast, procedural skills, communication and situation awareness were more closely associated with skill-based slips and lapses. Knowledge-based mistakes were less frequent but occurred in relation to hospital systems and procedural skills. Conclusions In order to improve the management of acutely unwell patients by junior doctors, medical educators must understand the causes of common errors. Adequate knowledge alone does not ensure prompt and appropriate management and referral. The teaching of acute care skills may be enhanced by encouraging medical educators to consider the range of potential error types, and their relationships to particular tasks and subjects. Rule-based mistakes may be amenable to simulation-based training, whereas skill-based slips and lapses may be reduced using strategies designed to raise awareness of the interplay between emotion, cognition and behaviour.
Related Links	https://bmcmededuc.biomedcentral.com/counter/pdf/10.1186/s12909-015-0285-6.pdf
Ending Page	8
Page Count	8
Starting Page	1
File Format	HTM / HTML
ISSN	14726920
DOI	10.1186/s12909-015-0285-6
Journal	BMC Medical Education
Issue Number	1
Volume Number	15
Language	English
Publisher	BioMed Central
Publisher Date	2015-01-16
Access Restriction	Open
Subject Keyword	Medical Education Theory of Medicine Bioethics Error Junior doctors Acute care Emergencies Framework analysis Theory of Medicine/Bioethics
Content Type	Text
Resource Type	Article
Subject	Education Medicine
Journal Impact Factor	2.7/2023
5-Year Journal Impact Factor	3.4/2023

Sl.	Authority	Responsibilities	Communication Details
1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
2	Indian Institute of Technology Kharagpur	Host Institute of the Project: The host institute of the project is responsible for providing infrastructure support and hosting the project	https://www.iitkgp.ac.in
3	National Digital Library of India Office, Indian Institute of Technology Kharagpur	The administrative and infrastructural headquarters of the project	Dr. B. Sutradhar bsutra@ndl.gov.in
4	Project PI / Joint PI	Principal Investigator and Joint Principal Investigators of the project	Dr. B. Sutradhar bsutra@ndl.gov.in Prof. Saswat Chakrabarti will be added soon
5	Website/Portal (Helpdesk)	Queries regarding NDLI and its services	support@ndl.gov.in
6	Contents and Copyright Issues	Queries related to content curation and copyright issues	content@ndl.gov.in
7	National Digital Library of India Club (NDLI Club)	Queries related to NDLI Club formation, support, user awareness program, seminar/symposium, collaboration, social media, promotion, and outreach	clubsupport@ndl.gov.in
8	Digital Preservation Centre (DPC)	Assistance with digitizing and archiving copyright-free printed books	dpc@ndl.gov.in
9	IDR Setup or Support	Queries related to establishment and support of Institutional Digital Repository (IDR) and IDR workshops	idr@ndl.gov.in

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