Family Physicians' Solutions to Common Medical Errors

One Pagers | Mar 15, 2003 Susan Dovey, MD, MPH; Larry Green, MD; Ed Fryer, PhD; Robert Phillips, MD, MSPH

In two U.S. studies about medical errors in 2000 and 2001, family physicians offered their ideas on how to prevent, avoid, or remedy the five most often reported medical errors. Almost all reports (94 percent) included at least one idea on how to overcome the reported error. These ideas ranged from “do not make errors” (34 percent of all solutions offered to these five error types) to more thoughtfully proposed solutions relating to improved communication mechanisms (30 percent) and ways to provide care differently (26 percent). More education (7 percent) and more resources such as time (2 percent) were other prevention ideas.

Of 416 error reports made by U.S. family physicians in two medical error studies done in 2000 and 2001, 151 (36 percent) were about the most commonly reported errors involving the processes of ordering medications, implementing laboratory investigations, filing forms and maintaining patient records, implementing medication orders, and responding to abnormal laboratory test results.

Although identifying medical errors is an important first step in making primary care safer for patients, the major challenge is in finding ways to avoid them. When asked for their ideas on how to overcome the most common medical errors they reported, family physicians offered 228 distinct solutions, categorized in the accompanying table.

Table. Categories of Solutions to Common Medical Errors Proposed by Family Physicians

Idea on Prevention, Avoidance or RemedyOrdering medications (54 reports, 87 ideas*)Implementing laboratory orders (27 reports, 41 ideas*)Filing system (25 reports, 40 ideas*)Implementing medication orders (24 reports, 34 ideas*)Responding to abnormal lab results (21 reports, 26 ideas*)Total (151 reports, 228 ideas*)
Idea on Prevention, Avoidance or Remedy: No idea reported†Ordering medications (54 reports, 87 ideas*): 1.9%Implementing laboratory orders (27 reports, 41 ideas*): 14.8%Filing system (25 reports, 40 ideas*): NAImplementing medication orders (24 reports, 34 ideas*): 4.2%Responding to abnormal lab results (21 reports, 26 ideas*): 14.3%Total (151 reports, 228 ideas*): 6.0%
Idea on Prevention, Avoidance or Remedy: Don’t make mistakes:Ordering medications (54 reports, 87 ideas*):  Implementing laboratory orders (27 reports, 41 ideas*):  Filing system (25 reports, 40 ideas*):  Implementing medication orders (24 reports, 34 ideas*):  Responding to abnormal lab results (21 reports, 26 ideas*):  Total (151 reports, 228 ideas*):  
Idea on Prevention, Avoidance or Remedy: Be more diligentOrdering medications (54 reports, 87 ideas*): 41.4%Implementing laboratory orders (27 reports, 41 ideas*): 12.2%Filing system (25 reports, 40 ideas*): 42.5%Implementing medication orders (24 reports, 34 ideas*): 20.6%Responding to abnormal lab results (21 reports, 26 ideas*): 26.9%Total (151 reports, 228 ideas*): 31.6%
Idea on Prevention, Avoidance or Remedy: Follow protocolsOrdering medications (54 reports, 87 ideas*): 1.1%Implementing laboratory orders (27 reports, 41 ideas*): 4.9%Filing system (25 reports, 40 ideas*): 2.5%Implementing medication orders (24 reports, 34 ideas*): 2.9%Responding to abnormal lab results (21 reports, 26 ideas*): 3.8%Total (151 reports, 228 ideas*): 2.6%
Idea on Prevention, Avoidance or Remedy: Provide care differently:Ordering medications (54 reports, 87 ideas*):  Implementing laboratory orders (27 reports, 41 ideas*):  Filing system (25 reports, 40 ideas*):  Implementing medication orders (24 reports, 34 ideas*):  Responding to abnormal lab results (21 reports, 26 ideas*):  Total (151 reports, 228 ideas*):  
Idea on Prevention, Avoidance or Remedy: Change established habitsOrdering medications (54 reports, 87 ideas*): 12.6%Implementing laboratory orders (27 reports, 41 ideas*): 9.8%Filing system (25 reports, 40 ideas*): 2.5%Implementing medication orders (24 reports, 34 ideas*): 5.9%Responding to abnormal lab results (21 reports, 26 ideas*): 19.2%Total (151 reports, 228 ideas*): 10.1%
Idea on Prevention, Avoidance or Remedy: Double-checking systemOrdering medications (54 reports, 87 ideas*): 10.3%Implementing laboratory orders (27 reports, 41 ideas*): 31.7%Filing system (25 reports, 40 ideas*): 12.5%Implementing medication orders (24 reports, 34 ideas*): 14.7%Responding to abnormal lab results (21 reports, 26 ideas*): 11.5%Total (151 reports, 228 ideas*): 15.4%
Idea on Prevention, Avoidance or Remedy: Better communication:Ordering medications (54 reports, 87 ideas*):  Implementing laboratory orders (27 reports, 41 ideas*):  Filing system (25 reports, 40 ideas*):  Implementing medication orders (24 reports, 34 ideas*):  Responding to abnormal lab results (21 reports, 26 ideas*):  Total (151 reports, 228 ideas*):  
Idea on Prevention, Avoidance or Remedy: With patientsOrdering medications (54 reports, 87 ideas*): 5.7%Implementing laboratory orders (27 reports, 41 ideas*): NAFiling system (25 reports, 40 ideas*): NAImplementing medication orders (24 reports, 34 ideas*): 11.8%Responding to abnormal lab results (21 reports, 26 ideas*): 3.8%Total (151 reports, 228 ideas*): 4.4%
Idea on Prevention, Avoidance or Remedy: Between providersOrdering medications (54 reports, 87 ideas*): 17.2%Implementing laboratory orders (27 reports, 41 ideas*): 26.8%Filing system (25 reports, 40 ideas*): 37.5%Implementing medication orders (24 reports, 34 ideas*): 32.4%Responding to abnormal lab results (21 reports, 26 ideas*): 26.9%Total (151 reports, 228 ideas*): 25.9%
Idea on Prevention, Avoidance or Remedy: More/better educationOrdering medications (54 reports, 87 ideas*): 6.9%Implementing laboratory orders (27 reports, 41 ideas*): 12.2%Filing system (25 reports, 40 ideas*): 2.5%Implementing medication orders (24 reports, 34 ideas*): 8.8%Responding to abnormal lab results (21 reports, 26 ideas*): 3.8%Total (151 reports, 228 ideas*): 7.0%
Idea on Prevention, Avoidance or Remedy: More resourcesOrdering medications (54 reports, 87 ideas*): 3.4%Implementing laboratory orders (27 reports, 41 ideas*): 2.4%Filing system (25 reports, 40 ideas*): NAImplementing medication orders (24 reports, 34 ideas*): NAResponding to abnormal lab results (21 reports, 26 ideas*): 3.8%Total (151 reports, 228 ideas*): 2.2%
Idea on Prevention, Avoidance or Remedy: † Percent of reports with no idea offered on prevention, remedy, or avoidance
* Remainder of the Table shows percentages of ideas

In 2000 and 2001, before patient safety was widely discussed in primary care settings, one third of family physicians' solutions for overcoming medical error were not very helpful - doing the same thing, but better. The practicing environment may make it difficult for physicians to think in terms of "systems" or to imagine alternatives to their immediate realities. Surprisingly, only a small minority of the other, practical, solutions for overcoming medical errors in primary care required additional resources, and these resources were almost always time rather than money. Specific changed habits such as stopping the use of carbon copy prescription forms, doing urgent lab tests in the office, and using flagging systems to draw attention to information needing action were all practical suggestions for alleviating these common errors. Various double-checking systems were also favored.

In searching for solutions to medical errors, asking those involved in providing care for their ideas may be a rewarding strategy.

The information and opinions contained in research from the Graham Center do not necessarily reflect the views or the policy of the AAFP. 

Published in American Family Physician, Mar 15, 2003. Am Fam Physician. 2003;67(6):1168. This series is coordinated by Sumi Sexton, MD, AFP Associate Medical Editor.