'Tempos' management in primary care: a key factor for classifying adverse events, and improving quality and safety.
BACKGROUND: The role of time management in safe and efficient medicine is important but poorly incorporated into the taxonomies of error in primary care. This paper addresses the lack of time management, presenting a framework integrating five time scales termed 'Tempos' requiring parallel processin...
| Publicado en: | BMJ Quality & Safety Vol. 21; no. 9; pp. 729 - 737 |
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| Autores principales: | , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
BMJ Publishing Group
Sep2012
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104420405&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 104420405 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 20445415 BFNQ jtl: BMJ Quality & Safety issn: 20445415 maglogo: N pubinfo: dt: Sep2012 vid: 21 iid: 9 pid: 8280 pub: BMJ Publishing Group artinfo: ui: 104420405 2011694443 10.1136/bmjqs-2011-048710 NLM22927486 PMC3436095 104420405 ppf: 729 ppct: 8 formats: tig: atl: 'Tempos' management in primary care: a key factor for classifying adverse events, and improving quality and safety. aug: au: Amalberti, R Brami, J affil: HAS, 2 avenue du stade de France, Saint Denis la Plaine, 93218 France; rene.amalberti@wanadoo.fr. sug: subj: Adverse Health Care Event Classification Physicians, Family France Primary Health Care Quality Improvement Time Management Access to Information Administrative Research Billing and Claims Statistics and Numerical Data Communication Barriers Correlational Studies Descriptive Statistics Diagnosis, Delayed Disease Surveillance France Health Services Accessibility Human Insurance, Liability Statistics and Numerical Data Quality Control (Technology) Record Review Retrospective Design Risk Management Methods Treatment Delay Uncertainty ab: BACKGROUND: The role of time management in safe and efficient medicine is important but poorly incorporated into the taxonomies of error in primary care. This paper addresses the lack of time management, presenting a framework integrating five time scales termed 'Tempos' requiring parallel processing by GPs: the disease's tempo (unexpected rapid evolutions, slow reaction to treatment); the office's tempo (day-to-day agenda and interruptions); the patient's tempo (time to express symptoms, compliance, emotion); the system's tempo (time for appointments, exams, and feedback); and the time to access to knowledge. The art of medicine is to control all of these tempos in parallel and simultaneously. METHOD: Two qualified physicians reviewed a sample of 1046 malpractice claims from one liability insurer to determine whether a medical injury had occurred and, if so, whether it was due to one or more tempo-related problems. 623 of these reports were analysed in greater detail to identify the prevalence and characteristics of claims and related time management errors. RESULTS: The percentages of contributing factors were as follows: disease tempo, 37.9%; office tempo, 13.2%; patient tempo, 13.8%; out-of-office coordination tempo, 22.6%; and GP's access to knowledge tempo, 33.2%. CONCLUSION: Although not conceptualised in most error taxonomies, the disease and patient tempos are cornerstones in risk management in primary care. Traditional taxonomies describe events from an analytical perspective of care at the system level and offer opportunities to improve organisation, process, and evidence-based medicine. The suggested classification describes events in terms of (unsafe) dynamic control of parallel constraints from the carer's perspective, namely the GP, and offers improvement on how to self manage and coordinate different contradictory tempos and day-to-day activities. Further work is needed to test the validity and usefulness of this approach. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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