Different accident analytical approaches have been utilised in safety-critical industries for analysing accidents and formulating safety recommendations. This study presents a ‘health informatics’ case incident of a patient adversely affected due to a medication dosing error resulting from a combination of contributing factors including those relating to the Computerised Order Provider Entry System. A comparative study was carried out using selected accident analytical approaches: Human Factors and Classification System, System-Theoretic Accident Modelling and Processes and Accident Modelling. Each resulting output was compared using the model characteristic criteria developed by Underwood and Waterson. Safety recommendations developed based on the outputs from the models/methods were also compared for any similar findings. It was acknowledged that while accident models incorporating ‘systems thinking’ can prove to be beneficial for healthcare in providing insight on systemic factors, there is a need for improving the reliability and validity of these models. This particularly applies to Rasmussen’s Accident Modelling approach to be considered useful in the healthcare domain.
This paper presents a field workshop organised by the Healthcare Improvement Scotland (HIS) focusing on the evaluation of the formalised AcciMap approach by patient safety practitioners of the National Health Service (NHS). Participants who were experienced in incident analysis relating to patient safety and risk management across different NHS boards but had no prior knowledge using the AcciMap approach were recruited for a case study analysis (Wrong Patient) (Chassin and Becher in Ann Intern Med 136:826–833, 2002). They were subsequently divided into three teams after introduction and training, where each team performed an independent case analysis. AcciMap outcomes produced indicated both similar and varying contributing factors identified by each team. This was also reflected in their formulation of safety recommendations. Their findings were then compared with each other (reliability) and with external review (validity). Based on results obtained from the survey instrument distributed after the exercise and focus discussions, the AcciMap approach was generally perceived as intuitive and a potentially relevant toolkit for incident investigations. However, questions were raised particularly regarding the usability (ease of use) in conducting analyses compared RCA techniques.
This chapter discusses the importance of applying methods based on the systems thinking paradigm in analysing accidents that may occur in a complex healthcare system involving telemedicine/telehealth. Different accident analysis approaches (models and methods) have been utilised to analyse incidents/accidents in different safety-critical domains, including healthcare, to identify weaknesses and to be able to propose safety recommendations. With the advent of systemic accident analysis (SAA) approaches based on the systems thinking paradigm, can they be feasibly and practically applied to incidents resulting from unintended issues relating to telemedicine/telehealth? This chapter discusses three popular SAA approaches, benefits and limitations, including their necessity for improving safety and even security relating to telemedicine processes.
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