Sept. 17-23, 1999
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Ethicist urges hospitals to learn from their errors

By Dan Heuchert

A leading bioethicist urged hospitals not to cover up their mistakes, but to study them, in the first Richardson Memorial Lecture at the Medical Center last week.

Analyses of hospitals' errors and problems "may provide a starting point for a more proactive approach to improving patient care and improving medical education," said Dr. Mark Siegler, director of the Center for Clinical Ethics at the University of Chicago, considered a pioneer in his field.

Siegler outlined a handful of studies of medical mistakes and discussed a study that he and a research team led of 1,047 surgical patients at the University of Chicago. The study's non-clinically-trained observers identified 2,183 "adverse events," suffered by 480 patients (46 percent); some 185 of the events were termed "serious," resulting in temporary or permanent disability or death.

The study found three factors associated with a greater likelihood of suffering adverse events: age (the older the patient, the more likely an error); intensive care unit stays; and length of stay (for every day in the hospital, there was a 6 percent increase in the likelihood of a mistake). Gender, race and who pays the bills were not factors, the study found.

And though health care providers fear legal liability for their mistakes, only 13 patients studied (1.2 percent) filed malpractice claims, he said.

The very fact that mistakes were studied is significant, said U.Va. Medical School dean Dr. Robert M. Carey. "It's really the opening up of an area that's very difficult to uncover," he said.

Carey expressed the hope that Siegler's talk would spark further discussion at the University Medical Center about how to address mistakes.

The annual lecture series, presented as part of the Humanities in Medicine program's weekly Medical Center Hour, was endowed by Dr. Donald R. Richardson, a Charlottesville dermatologist, in memory of his late mother. The lecture series is intended to urge health care providers to develop closer relationships with their patients.

"We need to progress, to bring the subject up over and over again," Dr. Richardson said. "We need to bring it into the mindsets of medical students, interns and residents."


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