Understanding medical error and improving patient safety in the inpatient setting.

Improving patient safety incorporates two complementary approaches. The first, inspired by research in cognitive psychology and the lessons of accident investigation in other industries, provides qualitative methods for anticipating errors, documenting critical incidents, and responding to them in a blame-free and structured manner. Using such qualitative methods, physicians can generate meaningful strategies for preventing similar occurrences in the future. Hospital-based physicians have an important role to play in promoting a culture of safety by championing incident-reporting initiatives and participating in multidisciplinary teams that analyze adverse events and promote change. The second approach involves applying the results of quantitative clinical research to reduce some of the common hazards of hospitalization. Hospitalists also have an important role to play in this arena because many of these safety targets and the associated clinical practices (e.g., early enteral nutritional support and fall prevention) are not on the radar screens of many hospital-based specialists. In both circumstances, physician participation in collaboration with nurses, pharmacists, nutritionists, and other health care professionals would likely produce important improvements in patient care. More important, physician involvement in these initiatives will undoubtedly contribute visible leadership in promoting a culture of patient safety in hospitals and in health care.