Factors affecting the medical errors of physicians working in the emergency department of Shahid Beheshti hospital in Shiraz

 

Mohammad Amiri¹, Abbas Yazdanpanah^2*, Jamalledin Alvaani³

 

¹Department of Healthcare Management, Marvdasht Branch, Islamic Azad University, Marvdasht, IRAN.

{²Assistant Professor, Department of Healthcare Management} {³Department of Psychology}

Marvdasht Branch, Islamic Azad University, Marvdasht, IRAN.

 

Abstract              Background and Aim: Medical errors are among the work-related and professional misconducts that individuals and owners of the profession commit while doing their professional and occupational tasks. In this study, a medical error means that there is a violation of the special requirements that the medical profession has to deal with. Method: This study is a descriptive-applied research in which the correlation method has been used. The research sample consisted of 17 physicians working in Shiraz University of Medical Sciences who were selected by simple random sampling method. In order to evaluate the variables, Ghanadi et al.’s (2010) questionnaire including personal and accountability factors, physician experience and diagnostic factors was used. Results: There was a significant relationship between variables of age (p <0.001), salary (p <0.001), remuneration (p = 0.018), service experience per year (p = 0.44), however, gender (p = 0.145) did not show to have a significant relationship with medical error. The relationship between the profile of individual factors and medical errors shows that there is a significant relationship between remuneration (p = 0. 317) and medical errors (p = 0.012), but there is no significant relationship between gender (p=0.145) and age (p = 0.007) of physician and medical errors. The value of t obtained is -4.04, which is significant with respect to the level of significance obtained (0.000) at the 99% confidence level. On the other hand, there is a significant difference between the medical experience and the medical errors, which confirms the second hypothesis. The value of t obtained is 0.638, which according to the level of significance obtained (0.001) is significant at 99% confidence level. The physician's accountability affects the medical errors. The value of t obtained is -2.571, which is significant with respect to the level of significance obtained (0.11) at the 95% confidence level. In other words, it can be said that gender has affected diagnostic factors. There is a significant difference between diagnostic factors and medical error. Therefore, the fourth hypothesis is confirmed. Conclusion: Medical errors education should be one of the operational objectives of medical schools in general and hospitals in particular, and this should be mentioned in educational planning.

Key Words: Medical errors, Physicians, Individual factors, Diagnostic, Shiraz.

 

INTRODUCTION

Medical services, while being made up of a set of services, include multiple people, equipment, hardware, and software applications. This extension of interactions makes health systems vulnerable to the occurrence of medical errors (Dabaghi and Fathi, 2006). Even the patient himself may make various mistakes in his illness. Medical errors are commonly found in hospitals and cause great harm to patients and the community (Sari et al., 2010). Today, the advent of modern medicine has led to complex forms of treatment and care processes that have improved care, but at the same time increased the likelihood of adverse events and injuries (Briner et al., 2013). Although there is no precise estimate of this problem, millions of people worldwide are likely to suffer from debilitating injuries or direct deaths due to medical errors (Jones et al., 2013). In classifying causes of death, medical mistakes are one of the top ten causes. In the last decade, patient safety has attracted widespread attention and has been raised as an international problem. Medical errors may occur when diagnosing a disease, prescribing drugs, performing surgery, using equipment, and reporting the results of tests, etc. (Behbahani, 2011). The results of research in the field of diagnostic psychology and influential human factors indicate that most medical errors are due to weakness in the systems in which the individual worked. In other words, most of these errors are due to failures in the design of processes, tasks, training, and working conditions that increase the likelihood of an error (Lester and Triter, 2001). It has been determined that ensuring patient safety before injury occurs is a professional concern of all those involved in patient care and patient safety is the first and most important issue inherent in professional identity (Chiosa and Ponzati, 2009). The first way to reduce medical errors is by identifying the underlying causes of their occurrence (Kingston et al., 2014). In addition, identifying and analyzing the causes and factors of medical errors can be effective in reducing them (Marcus, 2015). Regarding the aforementioned cases, this study aims to investigate the effect of factors related to the occurrence of medical errors of physicians working in the emergency department of Shahid Beheshti Hospital in Shiraz.

 

AIMS AND OBJECTIVES

The main objective: the main aim of the present study was to determine the effect of related factors on the incidence of medical errors of physicians working in the emergency department of Shahid Beheshti Hospital in Shiraz.

Special objectives: in the present study, the following specific objectives were also considered:

1. Determining the effect of individual physicians on the medical errors of physicians working in emergency department of Shahid Beheshti hospital in Shiraz;
2. Determining the effect of physician's experience on the medical errors of physicians working in emergency department of Shahid Beheshti Hospital in Shiraz;
3. Determining the impact of accountability on the medical errors of physicians working in the emergency department of Shahid Beheshti Hospital in Shiraz;
4. Determining the effect of diagnostic factors on medical errors of physicians working in emergency department of Shahid Beheshti hospital in Shiraz.

Hypotheses

1. Individual factors (gender, age, occupation, salary) of the physician affects the incidence of medical errors.
2. The physician's experience affects the incidence of medical errors.
3. The doctor's responsibility for the medical error is affected.
4. Diagnostic factors (evaluation, examination, para-clinical services) affect the incidence of medical errors.

Definition of key terms: Medical errors: The most widely known definition of medical errors worldwide is the definition derived from the Joint Commission on Health Care Organizations. According to the organization, medical errors are an unwanted act that is due to negligence or action that does not lead to the desired result in practice.

Experience: In fact, the experience of responding is timely, fast and accurate to events, and this reaction derives from the set of effects recorded during each event or after an event.

Accountability: accountability is defined as an obligation and an internal commitment by the individual to perform the desired activities that he has been entrusted to, which originates from inborn. A physician's accountability means that he knows that the patient is a person with rights that should have a human look, not a commercial and financial look, and, in practice, not look at his patient just as a patient and take his health responsibilities up to take full advantage of the outcome of the treatment.

 

MATERIAL AND METHODS

Research environment in this research, was Shahid Beheshti Hospital, which is affiliated to Social Security Organization of Fars province. The population of this study included all general and specialist physicians working in the emergency department of Shahid Beheshti Hospital in Shiraz (N = 145). Sample size: The sample consisted of 17 physicians of emergency department of Shahid Beheshti Educational and Therapeutic Hospital in Shiraz, affiliated to Social Security in Fars province who were selected by simple random sampling method (N= 17). Data collection: In collaboration with Shahid Beheshti Hospital affiliated to Social Security in Fars province, and after passing the administrative procedures and obtaining the necessary permits, the total number of physicians in the emergency department of Shahid Beheshti Hospital affiliated to Social Security of Fars province, which included 17 doctors, was identified. After collecting questionnaires, the relationship between using individual factors and medical errors, physician's experience in medical errors, physician accountability for medical errors, diagnostic factors (evaluation, examination, paraclinical services) were calculated based on medical errors.

Validity: Based on the questionnaire, its validity was designed by the expert of statistics and after design, confirmed by experienced and experienced people. Regarding face validity, the questionnaire by Ghanadi, Anbari and Raheem (2010) was first confirmed by the faculty members of medical science. Cronbach's alpha for the 17-member sample was 0.88 and for the individual factors subscales 0.738, the physician's experience 0.831, the accountability of the physician 0.885 and the diagnostic factors 0.689. This questionnaire showed to have a good content validity.

Reliability: In order to collect data, the questionnaires were distributed by referring to the relevant units in Shahid Beheshti Hospital. In order to avoid ambiguity, explanation was provided by the investigator to people on how to complete the questionnaires. At the ending hour of the working shift the distributed questionnaires were collected.

Data collection instruments: In this study, the followinginstruments were used for data collection:

A. Demographic questionnaire

B. Medical error questionnaire

Demographic questionnaire: This researcher-made questionnaire included 7 questions. It was firstly a part of the main questionnaire, which was later detached from the original questionnaire. This questionnaire was designed to measure the demographic and individual characteristics of respondents. Medical Errors Questionnaire: This questionnaire contains 31 questions developed by Ghanadi, Roham and Anbari (2010) to identify the medical errors and match with the physician. The questionnaire consists of three scales: individual factors, physician experience, and physician accountability and diagnostic factors (evaluation, examination, para-clinical services). In this questionnaire, the subscale questions are as follows: individual factors; questions 4, 8, 6, 11, 13, 14, 15, 16, 18, 19, 20, 21, 22; physician experience; questions 1, 2, 3, 5,  7, 9, 10, 12; accountability of the physician, questions 17, 23, 25, 26, 27, and interaction with the diagnostic factors (evaluation, examination, para clinical services) questions 24, 28, 29, 31. In this questionnaire, a lower score means matching medical error. The options for this questionnaire are very low, low, moderate, high, very high and always allocated from 1 to 5, respectively. The maximum total score of the questionnaire is 155 and at least that is 31.

Data analysis: In this study, descriptive statistics including frequency, mean and standard deviation and inferential statistics including exploratory factor analysis, and calculating the significance of t-test were used for data analysis.

Findings: Tables 1 and 2 present the relationship between the variables of individual physicians participating in the study with medical errors. As shown, among the variables of the study, according to Table 2, there is significant relationship in variables such as age (p <0.001), salary (p <0.001), remuneration (p = 0.018), service experience per year (p=0.44); however, there is no relationship between gender (p = 0.145) and medical errors. The relationship between the profile of individual factors and medical errors indicates that there is a significant relationship between remuneration (p = 0. 317) and medical errors (p = 0.012), however there is no significant relationship between physicians’ gender (p=0.145) and age (p = 0.007) and their medical errors.

DISCUSSION AND CONCLUSION

This study was designed to investigate the effect of related factors on the incidence of medical errors in physicians working in the emergency department of Shahid Beheshti Hospital in Shiraz, Iran. So the results of this study are helpful in identifying the type of errors and the factors causing them to prevent similar errors. It seems that it is possible to choose the method and design of treatment, lack of follow-up of patient's treatment, lack of facilities, lack of accurate history, lack of information about the patient's condition, absence of comprehensive examination, lack of control of bleeding are among the causes of the error in the treatment section. Therefore, it seems that more attention has to be paid considering human errors as the main causes of medical defects. Since human errors can be caused by numerous causes, including fatigue, lack of information and expertise, inaccuracy due to excessive self-confidence and so on, it seems that the investigation of the main cause of human errors in the occurrence medical conditions should be determined to provide a suitable way to prevent such errors. In a study by Kikavosi Arani and Nasiripour (2011), four evident threats to medical errors in public hospitals in Tehran province were identified, which in total justified 14.45% of the variance of the total data. The most powerful justification of the variance of the total data related to the service-provider with 7.81% and the lowest to the work environment with 81.1%. Therefore, it can be concluded that their result is consistent with the result of the present study. In a study by Howe et al. (2013), it was concluded that work-related fatigue, congestion, personal problems, and lack of experience are among the most important causes of medical errors. Other results showed that more than half of the medical errors were preventable. Therefore, it can be concluded that the result of the present study is consistent with those results. In a study, Tang et al. (2007) concluded that the majority of nurses (79%) believed that factors such as nursing carelessness and increased workload were factors influencing medication mistakes. They also concluded that the experience and expertise of nurses is one of the important factors in the occurrence of the errors that lead to the death of the patient. They state that medication mistakes and medical errors make the patient and his family reluctant to a health care system and increase costs. Therefore, it can be concluded that their research result is consistent with the result of the present study. Kashola et al. (2001) in a study concluded that 19.4% of medical errors were medication errors. 14% of medication errors result in death and cause 3% permanent damage. Other results showed that 69 percent of medical errors are preventable through tools such as information technology. Therefore, it can be concluded that the result of the present study is consistent with their research results. Lee et al. (2016) in their study concluded that effective hospital management has a significant effect on the reduction of medical errors. They stated that a professional management could prevent many medical errors. Other results of the study also showed that the satisfaction of staff and hospital staff could have a significant impact on the medical errors. Therefore, it can be concluded that the result of their research is consistent with the results of the present study. Also, the results of Wolf et al. (2006) showed that 75% of medical errors were caused by human factors such as experience, age, physical and mental status, and so on. Of these, 45% were due to lack of knowledge and skills. Therefore, it can be concluded that the result of their research is consistent with the results of the present study. The results of the study by Malekzadeh et al. (1395) can be used to plan for the prevention of any kind of error. The recommendations of the researcher to reduce the medical error include the following: the effect of the medical error on the quality of doctors' work; the effect of medical error and job environment and occupational stress among the other occupations in hospitals; the role of the gender factor (men separate from women) in the amount of medical errors in health care centers, etc. The process of comparing research conducted around the country to improve the medical error ran into some research limitations: conducting an interview was not possible due to the physicians’ lack of time. As a result, the questionnaire was used as the only means of data collection; lack of information and research related to medical errors, especially in the field of social security since, contrary to the efforts made, private hospitals did not allow to perform this research. It should also be noted that the generalization of the results should be carried out with caution, because the present study includes physicians of the social security affiliated hospitals of Fars province.

 

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