© 2003 BMJ Publishing Group & Institute for Healthcare Improvement
Action Points
| The first 150 words of the full text of this article appear below. |
In this case report from Australia the authors describe how data from a trainee anaesthetists performance monitoring programme turned anger into praise. The anaesthetist inadvertently inserted a pulmonary artery catheter sheath into a patients right carotid artery, resulting in haematoma, distress and dyspnoea. The patients family complained that a trainee had been allowed to risk a patients life, and asked how to start formal proceedings. The trainee, who was taking part in a monitoring programme, agreed for his professional record to be shown to the relatives. It showed that he had a very low complication rate for the procedure. "The family then understood more clearly that the sequence of events represented an unfortunate misadventure that could have happened in the hands of any experienced anaesthetist", write the authors. "They were also so impressed by the quality and clarity of the data . . . that they requested information on the
Relevant Articles
- Randomised controlled trial of a shared care programme for newly referred cancer patients: bridging the gap between general practice and hospital
- J D Nielsen, T Palshof, J Mainz, A B Jensen, and F Olesen
Qual. Saf. Health Care 2003 12: 263-272.[Abstract] [Full Text] [PDF]
- Guidelines and management of mild hypertensive conditions in pregnancy in rural general practices in Scotland: issues of appropriateness and access
- J Tucker, J Farmer, and P Stimpson
Qual. Saf. Health Care 2003 12: 286-290.[Abstract] [Full Text] [PDF]
- Less is (sometimes) more in cognitive engineering: the role of automation technology in improving patient safety
- K J Vicente
Qual. Saf. Health Care 2003 12: 291-294.[Abstract] [Full Text] [PDF]
- The value of personal professional monitoring performance data and open disclosure policies in anaesthetic practice: a case report
- S Bolsin, R Solly, and A Patrick
Qual. Saf. Health Care 2003 12: 295-297.[Abstract] [Full Text] [PDF]
Register for free content
The full back archive is now available for all BMJ Journals. Institutional subscribers may access the entire archive as part of their subscription. Personal subscribers will also have access to all content when logged in. Non-subscribers who register have free access to all articles published before 2006 right back to volume 1 issue 1. Register here to access the free archive of all BMJ Journals.
Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.
