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BACKGROUND

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Harm from medical mistakes can be catastrophic to the patient, and can also damage the reputation of a surgeon and institution. Today, patients, payers, and clinicians are increasingly recognizing the problem of medical mistakes as an epidemic, and scientists are describing mechanisms of preventable harm. The use of safety groups, briefings/checklists, and a management responsive to safety concerns are recognized to be pillars of the science of quality improvement. Transparency and independent peer review are the future.

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Safety concerns in health care came into public spotlight after a series of high-profile preventable errors. The first well known to medical educators is that of Libby Zion whose death in 1984 was attributed to physician resident fatigue. The result was implementation of the 80-hour work-week in the state of New York and subsequent adoption by the Accreditation Council on Graduate Medication Education (ACGME). A decade later the Dana-Farber Institute invested more than $11 million into a patient safety program after two patients within 2 days received chemotherapy overdoses resulting in one death and one irreversible heart injury (Table 5-1). These together with other widely publicized events led to the landmark Institute of Medicine (IOM) study, “To Err Is Human.” The oft-cited report concluded that every year more than 1 million injuries and 98,000 deaths in the United States occur from preventable medical mistakes.1 Since that report the field of patient safety has grown exponentially.

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TABLE 5-1

Landmark Patient Safety Cases in Oncology

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When compared to other critical industries, health care performs poorly in terms of its reliability. In addition to low efficiency, health care also houses an alarming high error rate. This chapter summarizes the important patient safety issues in the surgical oncology population and an update on the latest innovations in the field.

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EPIDEMIOLOGY

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Medical mistakes are common, costly, and in many cases may be preventable. After the initial IOM report of 98,000 deaths annually, a recent summary of the literature by ProPublica suggests that the annual deaths from errors are closer to 210,000 per year rather than 98,000 per year.2 In addition, approximately 1 in 10 patients who enter a hospital will be harmed by an iatrogenic cause.3 However, more updated studies suggest that the ...

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