Graduate Medical Education and Patient Safety

Kaveh G. Shojania; Kathlyn E. Fletcher; Sanjay Saint

doi:10.7326/0003-4819-146-9-200705010-00019

Letters |1 May 2007

Graduate Medical Education and Patient Safety

Kaveh G. Shojania, MD; Kathlyn E. Fletcher, MD, MA; Sanjay Saint, MD, MPH

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IN RESPONSE:

We thank Dr. Fine for his kind remarks about the Quality Grand Rounds series. Our article highlighted the importance of clear communication and the ways in which failure to explain key aspects of the care plan contributed to several errors in the case. We focused on physician trainees because of space limitations. However, we agree that poor physician–nurse communication contributed to the mistaken insertion of a feeding tube instead of a nasogastric tube, and failings in this area are an important source of medical errors.

We agree with Dr. Griner that the use of simulation promises to improve the acquisition of key procedural skills by trainees. A rapid response team may also have helped in the case, but the physicians' responses to the nurse's pages were in fact quite timely and the nurse seemed satisfied by the physicians' assessments. In other words, even if a rapid response team had been available in the hospital at the time, there was no indication that the nurse would have called for it. Moreover, despite widespread enthusiasm for rapid response teams, the only randomized, controlled trial to evaluate their efficacy showed no benefit (1) and other studies that have reported benefits suffer from important methodological limitations (2).

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2007 American College of Physicians

Letters |1 May 2007

Graduate Medical Education and Patient Safety

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Letters |1 May 2007

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