The Emergency Department is a unique environment to work in as a medical practitioner. The nature of the work we do, the unselected cohort of patients we see and the time and space pressures we work with all provide significant challenges and as a result the non-clinical skills of the healthcare workers are particularly important in the ED to ensure excellent patient care and patient safety are maximised.
Working in the Emergency Department often affords junior doctors a level of autonomy and independent practice they have not experienced before. As a result of this junior staff may find themselves having to break bad news, deal with dissatisfied patients or relatives and being involved in critical incidents perhaps for the first time.
The follow on from any mistake or incident should be clinical governance, which is a process by which looking at why thing went wrong should feedback no how to prevent it happening again. Understanding this and being involved in the process will allow you to implement positive changes in your department.
Learning Outcomes from completing the task
Recognise factors likely to lead to complaints.
Recognise that mistakes happen and it is important to be open about this.
Understand the consequences of medical error for those involved including the medical team.
Define Clinical Governance.
Recall the "Never Events" with reference to those that can occur in the ED.
Learning Outcome from face-to-face teaching
Outline the local complaints procedure.
Deliver an appropriate apology.
Distinguish between system and individual errors.
Complete the following before the face-to-face session:
Task 1: Complaints
Duration: 10 mins
This short article taken from an MPS casebook provides some basic info about how complaints are on the increase, why this is so and how they can be avoided.
Task 2: Doctors Make Mistakes
Duration: 20 mins
This excellent Ted talk addresses the culture around mistakes and how we should discuss them openly and learn from them... after all we all make them.
Task 3: the Second Victim
Duration: 6 mins
This short video by Prof. Simon Carley at #RCEM15 (Manchester) briefly discusses medical error and the second victim syndrome which is an important concept to be aware both personally and as part of team so that you can support colleagues.
TASK 4: Clinical Governance
Duration: 6 mins
Whilst this video was made for foundation doctors, it serves to define clinical governance and covers some of the processes contribute to it. It is therefore a good place for doctors of all grades to start.
Task 5: Never Events
Duration: 15 mins
This document written by RCEM covers all the recognised "never events" and highlights those that are at risk of occurring in the ED.
We have written a series of interactive cases (wikis) with short answer questions to be answered by trainees prior to the face to face teaching sessions. Currently this is only available to East Midlands Trainees.
Answer one or two questions before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. We will also provide tutor comments. If you find good resources that answer a question why not include links in your comment.
Part of the face-to-face teaching will be spent discussing the case(s) below:
Here are some extra resources to review if you want more information:
This article is available via Athens, despite being in an anaesthetic journal it looks at emergency medicine. The reality is that errors and critical incidents occur everyday and at some point we will all be involved. There needs to be a culture shift to accept this and look at how to move forward and prevent further incidents, this is perhaps something that anaesthetists do better than we do.
The article itself covers the types of error, how some errors compound each other and how this leads to the "swiss cheese model".
This quick guide from the BMA details the different complaints procedures within the UK. With some links for further reading and some advice for doctors who have received a complaint.
Once you have worked through the exercises, discussed the example cases and attended the face-to-face teaching, please complete the following form: