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When discussing quality of care always ask what question? |
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Definition
From the perspective of whom? |
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What is the only correct answer to "What is your error rate?" |
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Adverse drug reaction a ridiculous term? |
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What is the rate of impatient medication errors |
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Is education considered a system change? |
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T/F the last person involved in an error is responsible for the error |
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Definition
No. People are rarely responsible for errors. |
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Ernest Codman assessed outcome by |
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Donabedian assessed out com by |
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3 pieces of the Donabedian model framework |
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Definition
1. Structure (setting) 2. Process (How) 3. Outcome |
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Identify audience, and make it important to the audience |
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Attributes of a good metric |
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1. Clearly defined 2. Information rich 3. Sensitive to intervention 4. Actionable 5. Evidence based 6. Objective and unbiased 7. Feasible 8. Reliable/consistent 8. Leads to correct conclusion |
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Specific Meaningful Attainable Relevant Time-based Evaluated\engaged Reevaluated |
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Which hospital is safer? A: 100 errors reported --> 1 system change
B: 10 errors reported --> 5 system changes |
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