PROFESSION

Communication problems often initiate "cascades" of errors

A report shows that miscommunication, rather than incompetence, usually figures into errors at the primary care level.

By Andis Robeznieks, AMNews staff. Aug. 16, 2004.

The underlying cause for errors in primary care diagnosis or treatment more often than not could be miscommunication, according to a study in the July/August issue of the Annals of Family Medicine.

"Errors in diagnosis and treatment are often caused by errors in communication and not incompetence," said Steven H. Woolf, MD, a professor of family medicine at Virginia Commonwealth University in Fairfax, who co-authored the report.

The study analyzed 75 error reports from 18 family physicians in five states and concluded that a chain or "cascade" of errors was documented in 77% of the incidents. A full 80% of the error chains were initiated by miscommunication, including breakdowns between physician colleagues, misinformation in medical records, mishandling of patient requests and messages, inaccessible records and inadequate reminder systems.

"Many errors arose from specimens being mislabeled and charts being misfiled or missing," Dr. Woolf said.

Because so many diagnostic and treatment errors had their origins in miscommunication, Dr. Woolf and his colleagues suggest that safety initiatives should "focus less on professional interventions to improve clinical judgment and more on management systems to enhance the quality of information transfer."

Although he said most "docs in the trenches" are not inclined to perform a root-cause analysis on reported errors, Bruce Bagley, MD, medical director of quality improvement for the American Academy of Family Physicians, agreed that clear communication would go a long way in improving primary care safety.

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