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Training and dealing with errors or mistakes in medical practical procedures
  1. Department of Paediatrics
  2. University of Cambridge School of Clinical Medicine
  3. Addenbrooke's Hospital, Hills Road
  4. Cambridge CB2 2QQ, UK
  5. email:

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The complexity of treatment, procedures, interventions, and workload of modern, inpatient paediatric and neonatal care provides a setting where errors may, potentially, have serious adverse consequences for our patients. For the purpose of this article, an error is defined as clinical performance which deviates from an ideal and, as a result, could (or does) lead to an accident or an iatrogenic incident.1 ,2 Active errors are those that immediately precede an adverse event and latent errors are factors inherent to a system (for example, heavy workload, inadequate maintenance of equipment, or the prevailing professional culture) that provide the conditions in which an accident is inevitable if given the right set of circumstances. Since all physicians involved with acute or emergency care may be expected to perform practical procedures,3 we need to understand why our patients sometimes suffer as a consequence of a procedure, what mistakes occur, and how we can improve on our performance.

The scale of complications and deficiencies in practical skills

“All doctors, however experienced and conscientious make mistakes”.4 In the acute setting, in paediatric intensive care practice, Stambouly et alprospectively assessed the extent and consequence of human error.5 In their experience, 115 complications occurred during 83 of 1035 consecutive admissions over an 18 month period. In all, 5% to 17% (95% confidence interval (CI)) of these complications were procedure related. Human error was involved in 41 (95% CI, 27% to 45%) of these instances, 21 of which were considered to be of such consequence to the patient that life was threatened or that further therapy, specific to the intensive care unit, was deemed necessary. The extent of these problems is not only limited to the intensive care unit. In the emergency room, management skills of front line paediatricians may also be suboptimal. Among 34 paediatric trainees responsible for after hours …

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