Medical error is an unfortunate reality of the healthcare industry and a continuously discussed topic due to its grave impact on patient care and outcomes. In a 1999 publication by the Institute of Medicine (IOM), it was highlighted that deaths resulting from medical error exceeded those attributed to motor vehicle accidents, breast cancer, or AIDS. One study reported that approximately 400,000 hospitalized patients experience some preventable harm each year, while another estimated that >200,000 patient deaths annually were due to preventable medical errors. Moreover, the reported cost of medical errors is wide-ranging, with some experts estimating healthcare costs of $20 billion each year, while others approximate costs of $35.7 to $45 billion annually from hospital-acquired infections alone. Subsequent reports that discuss potential etiologies of medical errors have blamed systemic issues. Others have focused attention on certain groups of patients that may be more vulnerable to medical error than others. Recently, the impact of medical errors on a patient's family members and healthcare professionals has been emphasized due to its effects on exacerbating burnout, poor work performance, mental health decline, and even suicidal ideation.
Though pinpointing the definitive cause of medical error in certain situations may be challenging, evaluating strategies that can be used to mitigate and prevent these adverse events from occurring in the first place is essential. One such method is root cause analysis, which has been shown to reduce clinical and surgical errors in various specialties by establishing a quality improvement framework. This article will discuss the application of root cause analysis in medical error prevention and strategies for maintaining continuous quality improvement in the healthcare setting.
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