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Effective Clinical Practice

November/December 2000

ORIGINAL ARTICLES

What Is an Error?
Timothy P. Hofer, Eve A. Kerr, and Rodney A. Hayward

Reduction of medical errors has become a top agenda item for virtually every part of the U.S. health care system. To be considered an error, a failed process should have a clear link to an adverse outcome. Efforts to reduce errors should be proportional to their impact on outcomes and the cost of prevention.
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Developing a Culture of Safety in the Veterans Health Administration
William B. Weeks and James P. Bagian

The Veterans Health Administration has taken steps toward assuring patient safety by adopting a systems approach. The process, which involves a cultural transformation, faces many challenges, including avoiding bureaucracy and maintaining a high profile with continuous leadership support.
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How Many Deaths Are Due to Medical Error? Getting the Number Right
Harold C. Sox, Jr, and Steven Woloshin

The widely publicized report published by the Institute of Medicine on medical errors did not describe the methods used to derive its findings. As a result, speculation becomes a necessary hazard for persons interested in determining whether the numbers could be accurate.
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BACK OF THE ENVELOPE

Potential Reduction in Mortality Rates Using an Intensivist Model To Manage Intensive Care Units
Michael P. Young and John D. Birkmeyer

Growing evidence suggests that outcomes are better in intensive care units (ICUs) managed predominantly by full-time intensivists. Given the large number of ICU patients, even modest reductions in mortality rates would save many lives. However, the feasibility of fully implementing intensivist-model ICUs nationwide is uncertain.
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EDITORIAL

Is This Issue a Mistake?
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Primer On Dissecting A Medical Imperative
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SHORT ESSAYS

Medical Errors
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POLICY MATTERS

Media Mistakes in Coverage of the Institute of Medicine's Errors Report
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Federal Legislation Efforts To Improve Patient Safety
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Improving the Safety of Health Care: The Leapfrog
Initiative

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