2021_Book_TextbookOfPatientSafetyAndClin

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(only IM wards or all medical wards), study
design, and severity threshold of investigators in
the adjudication of events.
Medical errors — compared to surgical
ones — are more preventable (73% vs 53% [6];
75% vs 41% [7]), and often less overt because
diagnosis and time of occurrence can be less
clear and multiple providers are involved [11].
They are also associated to longer hospitalizations
being directly related to the time spent in
hospital [1, 12]. Indeed, they have been defined
“the hazards of hospitalization” [1]. They are
more common and severe in the elderly [10, 12,
13], and more events can occur in the same
patient [1]. Lower educational level, transfer
from other institutions, associated chronic conditions,
severe prognosis on admission, general
functional status on admission, level of awareness
on admission and at discharge, associated
kidney/liver failure or impaired function on
admission and at discharge, number of drugs
taken (on admission, during hospital stay, and at
discharge), patients’ knowledge about disease,
medications, and their side effects [9] are other
known risk factors for AEs in IM.
17.2 Most Common Errors
M. L. Regina et al.
In IM, errors can occur in any step of inpatient journey
from admission to discharge, and in any clinical
process from clinical history collection to diagnostic
work-up, drug therapy, invasive procedures, and
so on. Further, they can occur before admission to
IM and be recognized later, on the ward.
The words “error” and “AE” do not have the
same meaning. AEs are “injuries caused by medical
management rather than by the underlying
disease or condition of the patient”. Medical
errors can result or not in patient harm, but not
all of them lead to AEs. Generally, only preventable
AEs imply medical errors [14]. Table 17.1
displays the most frequent AEs occurring in IM,
according to hospitalization phase and process.
Table 17.1 List of the most frequent AEs in internal medicine according to hospitalization phase and process
Phase Process Adverse event Contributing factors
Pre- Initial assessment and
admission treatment
Incorrect/incomplete diagnosis
Incorrect/incomplete/delayed treatment
Reactions to drugs or transfusions
Inappropriate admission
Admission to inappropriate ward
Lack of patient information
Incorrect clinical reasoning
Busy and noisy environment
Fatigue, distraction
Bed unavailability
Lack, inadequacy, or violation
of policies on admission
appropriateness and hospital
patient flow
Admission Patient identification Tests and treatment to the wrong patient Identity documents not available
Patient cognitive impairment
Poor social support
Busy and noisy environment
Misunderstanding
Typing error
Inadequate or lacking
information technology
Lack, inadequacy, or violation
of policies
Clinical history
collection
Medication
recognition
Diagnostic omission or delay
Drug–disease interaction
Preventable adverse drug reactions,
including withdrawal reactions
Unintentional drug discrepancies
Administration delay
Inadequate skills
Physician knowledge deficit
Distraction, fatigue
Busy and noisy environment
Outlier status
Patient cognitive impairment
Poor social support
Lack of policy
Inadequate or lacking
information technology