Identifying causal patterns and errors inadverse clinical incidents

Rebecca Mitchell*, Ann Williamson, Brett Molesworth

*Corresponding author for this work

Research output: Chapter in Book/Report/Conference proceedingChapter

2 Citations (Scopus)

Abstract

This study identified precursor (PE) and associated contributing factors (CFs) of clinical incidents in health care. A random sample of 498 clinical incidents in Australiawere reviewed. Staff actionwas the most common type of PE identified. Correspondence analysis for all PEs that involved staff action by error type showed that rule-based errors were strongly related to performing medical or monitoring tasks and medication issues. Skill-based errors were strongly related to misdiagnoses. Factors relating to the organisation (66.9%) or the patient (53.2%) were the most commonly identified CFs for each incident. This study highlights the need for targeted approaches to tackling clinical incidents, based on an understanding of why they occur.

Original languageEnglish
Title of host publicationContemporary Ergonomics and Human Factors 2013
EditorsMartin Anderson
Place of PublicationBoca Raton, FL
PublisherTaylor & Francis
Pages277-284
Number of pages8
ISBN (Electronic)9780203744581
ISBN (Print)9781138000421
DOIs
Publication statusPublished - 2013
Externally publishedYes
EventInternational Conference on Contemporary Ergonomics and Human Factors 2013 - Cambridge, United Kingdom
Duration: 15 Apr 201318 Apr 2013

Other

OtherInternational Conference on Contemporary Ergonomics and Human Factors 2013
CountryUnited Kingdom
CityCambridge
Period15/04/1318/04/13

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  • Cite this

    Mitchell, R., Williamson, A., & Molesworth, B. (2013). Identifying causal patterns and errors inadverse clinical incidents. In M. Anderson (Ed.), Contemporary Ergonomics and Human Factors 2013 (pp. 277-284). Boca Raton, FL: Taylor & Francis. https://doi.org/10.1201/b13826-60