Medical Errors: Prevention, Communication, and Patient Safety, Exams of Medicine

Download Medical Errors: Prevention, Communication, and Patient Safety and more Exams Medicine in PDF only on Docsity!

HCL Final Questions with Correct Verified Updated

Solutions

1. How many people die every year in the US as a result of medical errors?: - 98,

2. Where would medical errors rank in terms of cause of mortality?: 3rd
3. What is it cost of medical errors annually?: 29B
4. List some ways to improve the amount of medical errors that occur: - ID the problem and underlying cause

• Account for human mistakes
• Create patient safety strategies
• Include patient in the process 5. What is the estimated amount of medical errors that have resulted in harm?- : 4 million - 8 million

6. What agency created patient safety indicators? What are they used for?:

• Agency for Healthcare Research and Quality (AHRQ) To help health care organizations/hospitals to assess, track monitor and improve patient safety

7. List some patient safety indicators: - Pressure ulcer rate

• Transfusion reaction rate
• Obstetric trauma rate
• Post op hip fracture rate
• Iatrogenic pnuemothorax rate

8. How many PSIs are there?: 25
9. List some types of medical errors: - Human mistake

• Process
• Medication
• Surgical
• Diagnosis
• Communication

10. How have modern patient safety movements sought to improve and de- crease medical errors?: "Blame and shame" of medical errors has been replaced with a systems approach that is often seen in airlines and nuclear power plants It acknowledges humans make mistakes and seeks to create strategies to anticipate, prevent, or catch unsafe events before they cause harm

11. Describe the swiss cheese model of medical error: When errors occur due to multiple layers of fails safes breaking down
12. List some things that are done to prevent surgical errors: - Preop verifica- tions

• Marking the surgical site
• Object counts
• Time out

13. What are diagnosis errors?: - The failure to establish an accurate/timely diag- nosis OR

• Failure to communicate the diagnosis to the patient

14. List some ways to prevent diagnosis errors: - Know your stuff/be educated

• Understand a patient's health literacy
• Understand any barriers
• Communicate

15. What type of error accounts for 80% of all medical errors?: Communications
16. Describe some communication causes of medical errors: - Discontinuity of care

• Inaccurate transfer of data

17. List the criteria that must be met when handing off patients: •Interactive communications

• Up-to-date and accurate information
• Limited interruptions
• A process for verification
• An opportunity to review any relevant historical data.

18. What is IPASS?: A tool used for verbal and written hand offs that has been proven effective in preventing communication errors

• I-illness severity, a one word summary of patient acuity
• P-patient summary: brief summary of diagnoses and treatment plan
• A-action list: to-do items to be completed by the clinician receiving sign-out
• S-situation awareness and contingency plans: directions to follow in case of changes in the patients status, often in an "if-

serious physical or psychological injury or the risk thereof"-Events that signal the need for immediate investigation

• Infant d/c to the wrong family
• Unexpected death of full term infant
• Wrong site/wrong patient surgery 25. What are some abbreviations that should not be used. What are their alternatives:

26. List some categories of preventable hospital acquired conditions: •Blood incompatibility

• Poor glycemic control

• Infections
• PTX

27. What is the anticipate method: Way to transfer care

• Administrative data accuracy
• New clinical information must be updated
• Tasks to be performed by the covering provider must be clearly explained
• Illness severity must be communicated
• Contingency plans for changes in clinical status must be outlined to assist cross coverage in managing the patient overnight

28. What is the PSMF: Patient safety movement foundation that ID problems and creates solutions. Some of their goals

• Unify healthcare
• ID challenges that are killing patients
• Promote transparency
• Reach goal of zero preventable deaths

29. Describe a patients role in preventing medical errors: SPEAKUP initiative

• Speak if you have questions/concerns
• Pay attention to the care you get
• Educate yourself about your illness
• Ask for an advocate
• Know what medicines you're taking and why
• Use vetted health care orgs
• Participate in all decisions about your treatment plan

30. List some rights a patient has at their appointments/the pharmacy and home: - To be an active participant in discussions

• To research their condition
• To receive the correct prescription

31. List some responsibilities a patient has at their appointments/pharma- cy/home: - To be open/honest about symptoms

• Voice concerns
• Verify they have the correct prescription

32. What is a health system: People and organizations that have the primary intent of promoting, maintaining o r restoring health
33. What are diagnostic related groups?: A classification system used by Medicare and Medicaid to determine payment for health services based on diag- nosis, regardless of the actual cost of care. Method of classifying inpatient stays for determination of payment

• Developed to decrease costs and lessen length of stay

34. What is a functional health system: •Patient centered

• Providers
• Organization-where HS can be integrated
• Environment

35. What is an integrated health system: A network of organizations that provides are arranges to provide coordinated continuum of care
36. What are the pros to integrated health systems: Provides entire services to communities and dissipates financial burden of malpractice
37. What are the cons to integrated health systems: Weeds out the small inde- pendent practices
38. What are horizontal integrated systems: A health system that allows single specialty (Like orthopedics) private practices to increase the number of patients seen, create a centralized billing process and partner with insurance companies to form HMO
39. What are vertical integrated systems: A health care system where all care is provided under one organizational roof
40. What is PCMH: Patient centered medical home: Strategy for primary care practice redesign
41. Describe the 7 principles/characteristics of Patient centered medical homes (PCMH): •Personal MD

• Team-based care
• Whole person orientation
• Integrated and coordinated care
• Quality and Safety
• Accessibility
• Affordability

42. What is a PAs role isn PCMH: Unclear. Most PCPs believe the reliance on midlevels is not a positive change
43. T/F There are statewide KY PCMH: F there are none as of this date
44. What are accountable care organizations: Multispecialty organizations that agree to be accountable for the quality and cost of care for a

define population of

• Where: In network
• Payment: Co payment schedule per visit or script

57. Who can you see, where can you be seen and what is the responsibility with PPO (preferred organization) health insurance: Who: Anyone in network. NO referral needed

• Where: In network
• Payment: Co payment

58. What are the pros and cons of PPO: Pros: NO referrals needed, Less expen- sive than Fee for service Cons: cost more than HMO
59. Who can you see, where can you be seen and what is the responsibility with Medicare: Who and where is limited

• Payment is determined by what plan

60. What are the pros and cons of medicare: - Pros: Low cost

• Const: Selective plan coverage

61. Medicare part A covers: Hospitalization, care in a skilled nursing facility, home health care, and hospice care and medical equipment (Inpatient)
62. Who is eligible for Medicare?: People age 65 and older and people suffering from long term disabilities or who are blind or widowed
63. Medicare part B covers:: Physician services, outpatient hospital services, durable medical equipment, and other services and supplies.
64. Which parts of Medicare are optional?: B, C, D
65. Medicare part C covers: Medicare Advantage, HMO
66. Medicare part D covers: Prescription drugs
67. Where can you be seen with Medicaid: Anywhere
68. What is the payment responsibility for Medicaid: Income based
69. What are the pros and cons of medicaid: - Pros: Good for fixed income

• Cons: Many providers don't take these patients

70. List that factors that go into the price of your health insurance premium:

• Age
• Health condition
• Job
• Social habits
• Lifestyle risks

71. What are CPT codes: Current Procedural Terminology:

a five digit numeric code that is used to describe medical, surgical, radiology, labora-

provid- ed by health care entities, appropriate to the evaluation and treatment of a disease, condition, illness or injury and consistent with the applicable standard of care.

90. Which code is for the entire encounter?: E&M (Evaluation and management codes)
91. Which code is for procedures?: CPT
92. Why is accuracy and specificity of diagnosis coding essential for appropri- ate service payment.: ICD-CM diagnosis codes determine the medical necessity for provided CPT services. The better you document the more accurate your billing
93. is when providers are inconsistent in conducting sound medical or business practices.: Abuse
94. is when a payment for items or services is obtained when there is no legal entitlement to the payment and the provider unintentionally misrepre- sents the facts to obtain payment.: Abuse
95. is intentional misrepresentation of a fact with the intent to deprive a person of property or legal rights.: Fraud 96. is when providers bill for services that were not actually provided- : Fraud
96. What is the reporting system of diagnoses to account for the reason seen and procedures ordered?: ICD (International classification of disease)
97. Describe the structure of ICD 10 codes: Three to 7 characters in length XXX.XXX(X) (3 digit category). (etiology) (anatomic site) (severity) (extension) (S42.001 A Fracture of unspecified part of right clavicle, initial encounter for closed fracture)
98. What are Z codes: Codes that show influencing health status (Z20 Contact with and suspected exposure to, communicable disease.)
99. First listed diagnosis is with outpatient or inpatient services?: Outpatient
100. What diagnoses are not coded for oupatient services: - Uncertain

• Signs/symptoms when the diagnosis is established 102. Is a principle diagnosis associated with oupatient or inpatient services?- : Inpatient

103. What is a principle diagnosis?: The main reason services were provided (Inpatient)
104. T/F, uncertain diagnoses can be coded for inpatient services: T.

• Etiology
• Acute v. chronic
• Initial v. subsequent encounter
• Routine or delayed recovery
• Disease combinations (manifestations, complications)
• Sequelae (late effects)
• Impending (threatened) conditions
• Complications of care

106. What does E&M coding require: That a medically appropriate and relevant history and/or examination is performed and documented
107. What are inpatient E&M codes based on?: HPI and PEx
108. What are outpatient consults E&M codes based on?: Time or complexity of MDM for office visits
109. Who is considered new patient for E&M codes: A person who has not been seen or had services from a provider within the same group
110. What is considered an established patient for E&M codes: A person who has been seen in the past 3 years by someone with the same tax ID in the same specialty. Or, has had professional services from ie. Hospital consult
111. What is a brief HPI: 1 - 3 OLDCARTS elements
112. What is an extended HPI?: - 4 or more OLDCARTS or

• 3 inactive chronic conditions

113. What is considered a pertinent PFShx?: Any one item that is directly related to the HPI
114. What is considered a complete PFShx?: 2 - 3 more elements depending on the patient
115. What is a problem pertinent ROS: Directly relates to the HPI
116. What is an extended ROS?: Related to problem and 2 - 9 more symptoms
117. What is a complete ROS: The problem and +10 more symptoms
118. A problem focused history has how many components for HPI, PFShx, and ROS. How many points is it?: - HPI: Brief

• PSFhx: None
• ROS: None 1

119. An expanded problem focused history has how many components for HPI, PFShx, and ROS. How many points is it?: - HPI:

Brief

• PSFhx: problem pertinent
• ROS: None

care pro- fessional HCP but involved in the patient's care