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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
CLINICAL RISK MANAGEMENT IN HEALTH SERVICE
Minerva Ortopedica e Traumatologica 2006 October;57(5):413-7
Clinical malpractice: le dimensioni del problema
Messori Ioli G., Pasqualucci A., Borsotti M.
Struttura Complessa Direzione Sanitaria Presidio Ospedaliero di Chieri –ASL 8, Torino
Health care is not as safe as it should be. A lot of studies suggest that medical errors are the main cause of death and injury. Although the literature pertaining to errors in health care has grown steadily over the last decade and some notable studies are particularly strong methodologically, we do not yet have a complete picture of the epidemiology of errors. Many studies centre on patients experiencing injury and provide valuable insight into the importance of harm resulting from errors. Other studies, more limited in number, focus on the occurrence of errors, both those that result in harm and those that do not (called “near misses”). Nowadays we known more about errors that happen in hospitals than in other health structures. Due to absence of standardized nomenclature, it’s difficult to synthesize and interpret the results in the literature connected with errors in “health world”. Medication-related error has been widely studied for several reasons: it is one of the most common types of error, large numbers of individuals are affected, and it is responsible for a considerable increase in health care costs. The lack of a standardized taxonomy for reporting adverse events, errors, and risk factors interfear with efforts to assess the importance of various types of errors. Even if in recent years, some progress toward a more standardized nomenclature and taxonomy has been made in the medication area, much work remains to be done.