Research on the development of improving working environment for the prevention of medical errors among residents

• Project/Area Number: 17590555
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Single-year Grants
• Section: 一般
• Research Field: Public health/Health science
• Research Institution: Tokyo Medical University
• Principal Investigator: TERUICHI Shimomitsu Tokyo Medical University, School of Medicine, Professor (90206243)
• Co-Investigator(Kenkyū-buntansha): YAMASHINA Akira Tokyo Medical University, School of Medicine, Professor (60317831) ; HIRAYAMA Yoji Tokyo Medical University, School of Medicine, Associate Professor (30246285) ; ODAGIRI Yuko Tokyo Medical University, School of Medicine, Assistant Professor (90276907) ; OHYA Yumiko Tokyo Medical University, School of Medicine, Assistant Professor (00074724) ; TAKAMIYA Tomoko Tokyo Medical University, School of Medicine, Assistant Professor (40366133)
• Project Period (FY): 2005 – 2007
• Project Status: Completed (Fiscal Year 2007)
• Budget Amount: ¥3,520,000 (Direct Cost: ¥3,100,000、Indirect Cost: ¥420,000); Fiscal Year 2007: ¥1,820,000 (Direct Cost: ¥1,400,000、Indirect Cost: ¥420,000); Fiscal Year 2006: ¥500,000 (Direct Cost: ¥500,000); Fiscal Year 2005: ¥1,200,000 (Direct Cost: ¥1,200,000)
• Keywords: medical errors / residents / instructors / working environment / stress / アクシデント / インシデント

Research Abstract

For the prevention of medical errors and improvement in quality of medicine, countermeasures for work-related stress through changing working environment are quite important, especially for residents who are at high risk for medical errors.
We collected information through meetings, in which residents and resident instructors discussed common medical errors, and their situations. Based on the results, we developed a questionnaire for residents to reveal work-related stressors and situations which lead to medical errors, and conducted a survey on five hospitals using the questionnaire. The survey showed that mean working hours was 75.8 hours. Among medical errors in the past 6 months, prescription errors were the most prevalent, at 62.2%, and information errors were 2nd prevalent, at 46.4%. Items related to these errors were "insufficient in confirmation", "insufficient in observation', "lack of knowledge or misunderstanding", "inexperience", and "lack of learning'. Perceived lack of kno wledge and skills were the most prevalent stressors for residents, and higher qualitative/ physical workload .and lower control and skill utilization, and higher scores of fatigue, anxiety, depression and psychosomatic stress responses were observed.
Based on these results, we developed a check-list for improvement in work-environment, in which resident instructors have on hand and alert residents on confirmation and facilitate communications with other medical staff as well as patients. We examined the effect of the use of this checklist by randomized control design subjected to 261 instructors in one hospital. Results showed that consciousness of resident instructors was raised and also frequency of confirmation by instructors to residents when conducting medical procedures was increased by intervention.
Therefore, instructors' use of the check-list is effective and may prevent medical errors by residents. The check-list developed in our study is significant in the possibility of introduction to hospital risk management systems.

Research Products

• [Presentation] 研修医による医療事故防止するための課題について (2007)
  • Author(s): 大谷 由美子
  • Organizer: 日本公衆衛生学会
  • Place of Presentation: 愛媛
  • Year and Date: 2007-10-25
  • Description: 「研究成果報告書概要(和文)」より
• [Presentation] Prevention of malpractice by medical interns (2007)
  • Author(s): Ohya, Y., Takamiya T., Odagiri, Y., Ishii, K., Inoue, S., Shimomitsu, T
  • Organizer: 6th Annual Meeting of the Japanese Society of Public Health
  • Place of Presentation: Ehime, Matsuyama
  • Year and Date: 2007-10-25
  • Description: 「研究成果報告書概要(欧文)」より