Editor's Page

Doing the Right Things: Eliminating Errors From Practice

Robert L. Edsall

Fortunately for family physicians, hospitals seem to have a monopoly on errors. At least that's the impression one would glean from the literature on errors in medicine. One reason so little energy is spent on studying errors in ambulatory care is that errors in that realm seem on the surface to be inconsequential on a societal scale - at least in comparison with, say, amputation of the wrong leg.

But it's not the societal costs of error I'm concerned about at the moment. Rather, I'm thinking about how errors in your practice may cost your patients, your staff and you. And the cost can't be measured adequately in terms of unnecessary morbidity, because it also entails waste of money and time, unnecessary phone calls, frayed tempers, lost productivity, late hours, lost revenue, worsening patient relations, lost opportunities, decreased staff satisfaction, and on and on. No matter how errors in office practice stack up against the rest of society's problems, the errors that occur in your practice are a significant problem for the practice and for you.

Call for manuscripts, tips and ideas

Family Practice Management is planning a special issue on error reduction in family practice for mid-2002. We hope you will find it useful - but for the moment we could use your help in making the issue as useful as it can be. We're looking for examples of how family practices have developed systems for catching or preventing errors, tips on how to prevent errors, and article submissions. If you think you can help, please let me know. My contact information is in the box below.

Got a system?

The range of errors we'll be discussing in the special issue is quite broad. It is not even limited to purely medical errors.

In Crossing the Quality Chasm, the Institute of Medicine defines error as "(1) the failure of a planned action to be completed as intended or (2) use of a wrong plan to achieve an aim."¹ If you'll pardon a simple-minded paraphrase, error is a failure to do the right thing or success in doing the wrong thing. Keep this idea in mind as you look back over your most recent day in practice, and I bet you'll be astonished at the number and glorious variety of errors you remember - the x-ray film that needed to be taken again because of underexposure, the chart that couldn't be found without a search, the claim submitted with an incorrect diagnosis code, the patient you didn't know was waiting to see you in Room 3, the prescription that the pharmacist couldn't read, the co-pay that went uncollected, the patient who applied amoxicillin liquid directly to her child's infected ear, the speculum that wasn't returned to the right drawer, the outdated handout you found in the patient information file, the callback that didn't get made, the lab report that got buried on someone's desk, the delays that kept you in the office late, the patients who hung up when they couldn't get through to your office on the phone, the latex gloves that arrived in size medium rather than large, the phone message that didn't get to you in time - should I go on?

That is what the special issue is about, and what we're asking your help with. If you have found a way to reduce the frequency of any kind of errors in practice - especially if you think it is something other family physicians would benefit from, we want to hear from you.

1. Committee on Quality of Health Care in America, Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001:45.

Robert Edsall is editor-in-chief of Family Practice Management. Conflicts of interest: none reported.

Send comments to fpmedit@aafp.org.

Copyright © 2001 by the American Academy of Family Physicians.
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