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Previous Volume 348:1051-1056 March 13, 2003 Number 11 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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An adverse outcome for a patient is difficult, sometimes traumatic, for all concerned. Such incidents pose considerable challenges to an organization, both in terms of the need to respond intelligently to their occurrence and in terms of the need to deal with their aftermath. The challenge is to find a way forward that provides the necessary support for the people involved while ensuring that the lessons of the incident are learned both by individual staff members and by the overall organization. In this article, I address two broad themes: first, how to investigate clinical incidents and learn useful lessons from . . . [Full Text of this Article]

Human Error and Systems Approaches in Medicine

Analysis of Clinical Incidents

Care-Management Problems

Identification

Clinical Context and Patient-Related Factors

Contributory Factors

The Investigation Process

The Effect of Adverse Incidents on Patients and Families

Caring for Patients Harmed by Treatment

The Effect of Adverse Incidents on Staff

Supporting Staff after Adverse Incidents

Conclusions

Source Information

From the Department of Surgical Oncology and Technology, Imperial College School of Science, Technology, and Medicine, St. Mary's Hospital, London.

Related Letters:

Understanding and Responding to Adverse Events
Thomas M. V.
Extract | Full Text | PDF  
N Engl J Med 2003; 348:2580, Jun 19, 2003. Correspondence

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