Medical Errors in Healthcare: How Being Rushed and Distracted Puts Patients at Risk

I was driving to a speaking engagement this week when I averted killing the driver of another motor vehicle. I was driving at the posted speed limit when a car sped out from a side road. Had I not applied my brakes, I would have T-boned his car. What was the reason for this? Obviously, the other driver was in a big rush to get to his place of employment on time and did not pay attention to his surroundings.

My close friend, Mike, had a herniorrhaphy and developed a urinary tract obstruction, and had been catheterized a few days earlier in an ER. He was sent to a urology office for the removal of his catheter. Upon his entering, the CMA called him into a treatment room and told him that first he needed to give her a urine sample, and handed him a cup. Obviously, she had not read his chart, because he replied that it would be difficult because he was being seen for a catheter removal. She was so rushed that she made the cardinal mistake of not reading the chart.

A scenario like the one I described is not unusual in this 21st-century medical system, where a clinician has less than 10 minutes to speak with a patient and read their chart. They have become so preoccupied with their EMR that they sometimes fail to look at their patient and recognize the obvious reason for the appointment. Being rushed by the executives of these systems and being penalized for spending too much time with a patient are primary causes of medical errors and missed diagnoses. Another problem is that one of the front door personnel may open your door to tell you that you are behind and have numerous patients to treat. These distractions can destroy our focus and cause us to miss pertinent data.

I can easily understand why all professionals are stressed and feel rushed, which has become a source of distraction. I considered which specialties this may occur in. Urgent Care, Emergency Medicine, Primary Care, Dermatology (I still have not had a full-body checkup in almost 10 years) hospital rounds and surgery, which I plan to address soon.

One of the most often missed diagnoses is first recognized in a hospitalized patient with a UTI. A UTI that is not followed carefully becomes pyelonephritis, which, if it is not followed carefully, becomes sepsis. What are we looking for in our patient who has advanced to this diagnosis? Fever, tachycardia, and decreased urine output all present before hypotension. Vital signs are taken by CNAs each shift, sometimes twice; however, to some, as not to penalize all, this is a duty, a chore, and they may not understand the ramifications of this sacred trust. We are the medical professionals who are responsible for the patient, and therefore, we need to utilize our thinking and skills to prevent a catastrophe, such as death.

In emergency medicine, we are taught in cardiac events or CVA, that time is tissue. How important? Remember the golden hour. But some problems have a shorter time than this. If we go back to the hospital and our initial patient, it could only be minutes. A normal BP can mean that shock is knocking at the back door. What time-related delays could make the final difference? Labs, cultures, and proper antibiotic therapy, with an emergency call to ID. These ramifications prove that minutes may matter. A nursing expression that I have heard my mother-in-law use as a director of nursing is that “sepsis does not scream about its presence, it whispers -until it screams.” Focus, focus, focus is the keyword to this article. We cannot permit the distractions aforementioned, and if they occur on a consistent basis after bringing this to the attention of the responsible supervisory or executive staff, then our only option to avoid permissive violation of patient time is to start your search for a new position, in a new office or system.

Sometimes friends and colleagues complain to me that I deliver good thoughts that are important to put into practice, but ask why I always make an advertisement about personal liability insurance. In 1975, I met Richard Sullivan, the President and CEO of CM&F, who wanted to groom me to become an article writer for CM&F. He encouraged me and set my article length at 400 to 800 words. We agreed on a monthly stipend for my time and writing, as well as my influence. At that time, I was the president of the New York State Society of Physician Assistants, the largest constituent chapter of the AAPA. It is now 30 years later, and I never asked for a raise under my 1975 agreement. The reason I continued my work, added occasional podcasts, and responded to PAs and NPs when they requested it, while always adding other services at no charge, was a burning desire to serve the team members.

Who are the members of the team? I consider every nurse, PA, and NP a member of a team dedicated to providing excellent care. I am not talking about them receiving pay, but giving care that was up to date and delivered in a fashion beyond the expectations of our employers. Therefore, today, I continue to bring to the forefront thoughts on the delivery of our care and try to solve the problems that exist as we endeavor to provide the best quality of patient care to all those who believe in our profession, as well as to their families, and in us, as individuals. Once again, I urge all clinicians and professionals to obtain personal liability insurance. Why? Because this is the only way we can continue to perform other life responsibilities unhindered by the fear of possible litigation, or by an employer who has not paid our malpractice insurance because they forgot or handed this responsibility to their office manager, or have joined another system with a completely different set of coverage. This is your responsibility! Only you can make the difference between having the appropriate coverage from a company that has been 100 percent consistent in offering not just insurance, but support at every other level. I ask you to consider these valuable suggestions and, as always, ask: what will you do?

Written For CM&F By: Robert M. Blumm, PA, DFAAPA, PA-C Emeritus
CM&F Clinical Advisor