tag:blogger.com,1999:blog-4968787219619380438.post9100144879625513223..comments2023-09-21T04:02:29.457-04:00Comments on Skeptical Scalpel: A medical riddle: Where do incident reports go?Skeptical Scalpelhttp://www.blogger.com/profile/13206922456661320751noreply@blogger.comBlogger21125tag:blogger.com,1999:blog-4968787219619380438.post-56125797830740156242015-12-02T13:51:48.137-05:002015-12-02T13:51:48.137-05:00Ben, of course I read that Atlantic article when i...Ben, of course I read that Atlantic article when it first came out. It has a catchy title. I'm sure it got a lot of clicks. It is hardly scientific. The author even says "The stories and anecdotes I collected…" In fact, it is entirely stories and anecdotes. <br /><br />Yes, some surgeons behave badly, but there are assholes in every profession including law, finance, real estate, journalism, and many more. In the first paragraph, the author also said, "No, not all surgeons are assholes. There are plenty who are amazing and generous people."<br /><br />Basing one's opinion of an entire group of people on an article full of hyperbole is unsound.<br /><br />Surgeons are not preventing incident reports from being filed or analyzed. The days of surgeons running hospitals and dictating policy are long gone.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-64645514817454403242015-12-02T13:20:30.439-05:002015-12-02T13:20:30.439-05:00I think part of the reason is that there is the fe...I think part of the reason is that there is the fear that an incident report would lack legal immunity and might therefore be used against the practitioner in any disciplinary or possible criminal action.<br /><br />My perception as a layperson also is that doctors particularly have a certain arrogance and strongly resent anyone from outside interfering in their domain.<br /><br />I think this was to some extent borne out recently by an article I read recently which concluded surgeons were particularly likely to be rude and arrogant; Why are so many surgeons assholes - http://www.psmag.com/health-and-behavior/why-is-my-surgeon-acting-like-biff-from-back-to-the-future. I discussed with a couple of friends who work in healthcare and their response was that the article was 100% true.<br /><br />With that attitude what are the chances of getting any sort of meaningful incident reporting system?Ben Thomasnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-10323861104319921292015-12-01T09:42:20.339-05:002015-12-01T09:42:20.339-05:00Ben, thanks for the comments. I agree that most in...Ben, thanks for the comments. I agree that most incident reports are about moans and perceived slights. As such, they don't deserve to be investigated. I wonder why in an environment such as you describe in New Zealand, your attempt to set up an incident reporting system like the airlines was meant with hostility.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-91859506578947721372015-11-30T16:51:35.885-05:002015-11-30T16:51:35.885-05:00Interesting; I have been involved in healthcare ri...Interesting; I have been involved in healthcare risk management in the past and often wondered the same thing. Incident reports I have seen fall into categories of 'having a moan (not enough equipment)' 'pursuing a grievance(Doctor x was rude to me) and when clinical staff were asked why they did not fill in incident reports more often the response was 'that they never produced results'.<br /><br />What also interests me is that by comparison incident reporting in aviation works much better (I think it is called ICARUS). I believe it can be anonymous and is protected against disclosure or use in proceedings. Perhaps healthcare should try something similar although when I have suggested I have been met with hostility for some reason. Incidentally I am based in New Zealand and we do not have the litigious environment of the USA and doctors here are protected by 'no fault' legislation that provides for state compensation for accidents and medical mishap. Doctors can only be sued in exceptional circumstances.Ben Thomashttps://www.blogger.com/profile/06273773374616566109noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-71982008263218680272015-11-29T13:13:40.977-05:002015-11-29T13:13:40.977-05:00In most hospitals today, sticking yourself with a ...In most hospitals today, sticking yourself with a needle would involve a trip to employee health or the ED where the event would be documented and HIV prophylaxis would be started or at least considered. I'm not a lawyer so I can't comment on what the workers comp situation would be for a non-employee.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-20043639894409624092015-11-28T18:24:44.675-05:002015-11-28T18:24:44.675-05:00I remember operating on a cirrhotic's "cr...I remember operating on a cirrhotic's "cracked liver". Yep...you read that right. Anyway, I stuck myself with a suture needle. Promptly I did everything I knew how to do...to try to prevent getting Hep C. A nurse promptly said, "make sure you fill out an incident report."<br /><br />I thought about it and realized: I'm not an employee of this hospital, I accidentally stuck myself, they're not going to pay for my Hep C testing; I maintain my own health and disability insurance. Why would they care? My disability company, IF I DID contract Hep C would only try to get out of paying the claim.<br /><br />I filed nothing. I didn't get Hep C. And nobody cared or said anything, anyway.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-32026915041560652342015-11-26T07:56:57.585-05:002015-11-26T07:56:57.585-05:00We had placed the bone flap in a small saline soak...We had placed the bone flap in a small saline soaked towel. The scrub nurse grabbed it thinking she had a grip on the towel and skull flap while, in reality, she had a grasp only on the towel. The bone flap fell to the floor. We got really paranoid after that and only handled skull flaps over the Mayo stand just in case they fell.<br /><br />Happy Thanksgiving to you Dr. Skeptical.Oldfoolrnhttps://www.blogger.com/profile/01747485143127099085noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-82430765967143576782015-11-26T07:41:11.367-05:002015-11-26T07:41:11.367-05:00Skull flaps must be slippery. I've heard many ...Skull flaps must be slippery. I've heard many similar stories. They don't seem to get infected after being dropped either.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-32605768831835140922015-11-25T20:58:14.991-05:002015-11-25T20:58:14.991-05:00When I was working really bad events were not repo...When I was working really bad events were not reported. During a craniotomy, a patient's skull flap was dropped on the floor. We rinsed it off as best we could, but word of the incident never left Room "K" of the OR. Luckily, the patient was fine. <br /><br />When incident reports were filed they went to the Director of Nursing and then to Hospital Administration. We used them as tools to obtain needed equipment or supplies by suggesting the whole SNAFU could have been averted if we had a new such and such gizmo.Oldfoolrnhttps://www.blogger.com/profile/01747485143127099085noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-91323940962182279622015-11-24T08:09:32.019-05:002015-11-24T08:09:32.019-05:00Anon, Good for you. I have never seen any signific...Anon, Good for you. I have never seen any significant change from an incident report only. I suppose it could happen.<br /><br />Florid, I agree that incident reports are often about small things. Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-78670574341677162002015-11-23T21:05:20.412-05:002015-11-23T21:05:20.412-05:00It's about liability. Part of the nurse-employ...It's about liability. Part of the nurse-employee's role is to protect the employer by documenting potential risk. The lawyers and their minions probably ARE reading these, but the quality assurance committees (I've sat on them, too) are not. An incident that rises to the level of quality assurance review often starts with an incident report, though. Most of them simply don't make it up to the full committee. They're often about small things, in truth. florid nightingalehttps://www.blogger.com/profile/11695630762612540503noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-49784191882277570912015-11-23T18:35:34.739-05:002015-11-23T18:35:34.739-05:00I think it depends on the facility. I have seen d...I think it depends on the facility. I have seen department policy changes after serious reports or events.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-60291708253583309892015-11-23T13:11:14.467-05:002015-11-23T13:11:14.467-05:00Great. They are reviewed. But does anything change...Great. They are reviewed. But does anything change after the review? Does anyone get feedback? How have your incident reports improved patient care or anything else about your hospital?Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-20037346997336010872015-11-23T13:02:49.638-05:002015-11-23T13:02:49.638-05:00These are absolutely reviewed at our facility, but...These are absolutely reviewed at our facility, but apparently not by surgeons based on this article and the comments.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-5065328119060911642015-11-23T07:10:02.347-05:002015-11-23T07:10:02.347-05:00Libby, if your house burns down, at least the stov...Libby, if your house burns down, at least the stove company will have an incident report. :-)Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-18331549806281859792015-11-22T17:26:25.791-05:002015-11-22T17:26:25.791-05:00yeah I think they're not often used...or rarel...yeah I think they're not often used...or rarely used. We bought a stove a couple of years ago that is a fire hazard. It arced while cooking & was still covered by warranty so was attended to. This year the replacement parts have melted together with the connectors & evidence of sparking was above the parts (all under the stove top). I phone the company & he says that because it is past warranty (ignoring that the problem possibly started before it ran out) can't fix it unless we pay. He will however fill out a incident report. I told him that meant nothing & we will still have a fire hazard for a stove. <br />I have seen them used for betterment of the company. I can't remember where so maybe I'm dreaming.<br />Egerton: I hope that politician didn't get elected.Libbyhttps://www.blogger.com/profile/09274573439351833726noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-14848466785047184802015-11-22T14:45:14.316-05:002015-11-22T14:45:14.316-05:00Great comments all. I particularly liked the one a...Great comments all. I particularly liked the one about the politician. Maybe incident reports are a kind of catharsis. You write the report and send it. You immediately feel better and then forget about it.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-33139384116807858982015-11-21T17:27:59.848-05:002015-11-21T17:27:59.848-05:00Yeppers, nothing but for the risk management/lawye...Yeppers, nothing but for the risk management/lawyers. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-25551975386873185762015-11-20T19:11:57.549-05:002015-11-20T19:11:57.549-05:00My suspicion was always that they were meant to be...My suspicion was always that they were meant to be forwarded to the hospital lawyer 'just so they know'. They would probably then wait to see if any litigation occurred and only then take a look at the 'incident report'. You have to keep the lawyers busy. No incident reports, decreased legal bills... Who wants that? Isn't it a great feeling being paid (while filling out incident reports at work) to find work for lawyers? They're also used by clumsy, uncooperative physicians to threaten nurses to do it the way the doctor wants or 'I'll file an incident report'. A multi-use document. RobertL39noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-3022704601112876542015-11-20T14:59:50.954-05:002015-11-20T14:59:50.954-05:00I once canvassed for a local politician seeking el...I once canvassed for a local politician seeking election. We were told to knock on doors, explain which party we were from and ask residents what issues they cared most about. I knocked on doors and faithfully made a list. When we stopped for lunch, I gave the list (lots of complaints about overgrown bushes, etc!) to the politician who laughed and threw it in the trashcan. Apparently finding out what people cared about wasn't the aim of the exercise at all...Anonymoushttps://www.blogger.com/profile/03239059138139486452noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-6131164199004720042015-11-20T14:17:10.179-05:002015-11-20T14:17:10.179-05:00Yes. Incident reports are meaningless.Not only in ...Yes. Incident reports are meaningless.Not only in medicine .<br />I recently heard that those little requests for feedback from you when you stay at a hotel are routinely thrown in the trash. I have always felt that if someone wanted my opinion about how much I enjoyed my hotel stay they should be willing to pay for it. And by payment I do not mean " a chance to win a cup of coffee at Starbucks ". Consequently, I never answer survey questionnaires. If they want my opinion,then give me a call and we will talk ( for a fee).William Reicherthttps://www.blogger.com/profile/10062067819184876941noreply@blogger.com