Patient Safety and Quality Improvement
 Modules  Module 2: History of Patient Safety/Clinical Quality Improvement
1. Introduction to Course
2. History of Patient Safety
3. The Science of Human Error
4. The Analysis of Medical Error
5. Evidence-Based Medical Practice
6. Communication and Information Transfer
7. Adverse Patient Outcomes
8. The Role of the Patient and Family
9. Environmental Safety in the Medical Setting
10. Safe Medical Practice In Ambulatory Settings

Philadelphia County Medical Society

1935 – Anesthesia Mortality Committee
1940 – Anesthesia Study Commission

Goal:

  • To open discussion of adverse outcomes related anesthesia and surgery (anesthesiologists and surgeons participated in these meetings)

Tension between educational goals and fear of incrimination among participants – some physicians reluctant to discuss their adverse outcomes for fear of losing reputation for “excellence” among their colleagues.

(Ruth, 1945; Orlander, Barber, Fincke, 2002)

 
 
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