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You are on the Endocrine surgery service and have been involved in the care of a 58-year-old woman who had an enucleation of an insulinoma from the head of her pancreas a week ago. At the time of that procedure, 1 drain was left anterior to the head of the pancreas and one drain was left posterior to the head of the pancreas. One of those drains, the posterior one, has actually had very little output over the last 48 hours and your chief resident has asked that you go pull that drain. You have been appropriately instructed in how to remove an abdominal drain, and you proceed to remove the drain. However, after doing so, much to your horror, you realize that although you were asked to remove the posterior drain, in fact, because of some confusion on your part as to which drain was which, you have removed the anterior drain. You realize this after the patient began complaining of abdominal discomfort and spiked a fever 12 hours after the drain removal. The attending and senior surgical residents are in the operating room and you have discussed this with them and they have explained that it is now necessary for this patient to have a CT scan.

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1. Should the patient be told that an error occurred?

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2. How would you address this error with the patient?

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Errors

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Answers
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  1. According to the Institute of Medicine’s To Error is Human report, an error is defined as either the failure of a planned action to be completed as intended (ie, an error of execution) or the use of a wrong plan to achieve an aim (ie, error of planning). As noted in the report, medical errors are one of the leading causes of death in the United States. Medical errors may rank as high as the fifth leading cause of overall death in the United States, exceeding the number of deaths that occur from motor vehicle accidents, breast cancer, and AIDS combined. In the years since the IOM report was published, research has revealed that errors are a growing problem. Since all medical and surgical care is provided by humans and humans are fallible, we know that errors will occur. Patients also know that errors can occur even with the best of intentions to avoid them. An honest discussion of what happened and how it happened is essential. Years ago, many physicians felt that to admit an error would be tantamount to inviting a lawsuit. In fact, the preponderance of data suggests that honest and prompt disclosure of errors is an important factor in reducing malpractice suits. More importantly, however, honest and prompt disclosure of errors is essential for the honest and ethical relationship between a patient and his or her physicians.

  2. As noted above, prompt and frank disclosure of errors ...

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