Patient Safety and Quality Improvement
 Modules  Module 7: Adverse Patient Outcomes
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

IOM Paper

  • Numbers are controversial
    • Retrospective review
    • Association of error with outcome
      • Not causation
    • No correction for Quality-Adjusted Life Year (QALY)
    • No correction for predicted mortality
    • May be off by factor of 10
  • Problem is not controversial
 
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