Zusammenfassung
Dieses Kapitel widmet sich der Definition und Erklärung von „Human Factors“ im Kontext von Patientensicherheit, die für Sicherheit und Zwischenfälle eine zentrale Rolle spielen. Human Factors auf den Ebenen des Individuums, des Teams, der Organisation und der Technik sind Teil von interagierenden Prozessen, die als Gesamtnetz zur Fehlerentstehung führen. Das Kapitel zeigt die Dimension von Fehlern in der Akutmedizin (Präklinik, Notaufnahme, Intensivstation, Anästhesie) und gibt erste gedankliche Anregungen, wie man sich dem Handlungsfeld der Humanfaktoren positiv-konstruktiv nähern kann.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Literatur
Ahmed AH, Giri J, Kashya R, Sing B, Dong Y, Kilickaya O, Erwin PJ, Murad MH, Pickering BW (2013) Outcome of adverse events and medical errors in the intensive care unit: a systematic review and meta-analysis. Am J Med Qual. https://doi.org/10.1177/1062860613514770
Aktionsbündnis Patientensicherheit (APS) (2007) Agenda Patientensicherheit 2007. APS, Berlin
Aktionsbündnis Patientensicherheit (APS) (2008) Agenda Patientensicherheit 2008. APS, Berlin
Amalberti R (2013) Navigating safety: necessary compromises and trade-offs-theory and practice. Springer, Heidelberg
Arntz HR, Klatt S, Stern R, Willich SN, Bernecker J (1997) Sind Notarztdiagnosen zuverlässig? Notf und Rettungsmedizin 0:12–19
Badke-Schaub P, Hofinger G, Lauche K (2012) Human Factors. Psychologie sicheren Handelns, 2. aktual. Aufl. Springer, Heidelberg
Bainbridge L (1983) Ironies of automation. Automatica 19(6):775–779
Beecher HK, Todd DP (1954) A study of the deaths associated with anesthesia and surgery. Annuals of Surgery 140:2–34
Bernius M, Thibodeau B, Jones A, Clothier B, Witting M (2008) Prevention of pediatric drug calculation errors by prehospital care providers. Prehosp Emerg Care 12(4) 486–94
Bigham BL, Buick JE, Brooks SC, Morrison M, Shojania KG, Morrison LJ (2012) Patient safety in emergency medical services: a systematic review of the literature. Prehosp Emerg Care 16(1):1–20
Brown LH, Hubble MW, Cone DC, Millin MG, Schwartz B, Patterson PD, Greenberg B, Richards ME (2009) Paramedic determinations of medical necessity: a meta-analysis. Prehosp Emerg Care 13(4):516–527
Catchpole K (2013) Spreading human factors expertise in healthcare: untangling the knots in people and systems. BMJ Qual Saf 22(10):793–797
Carron PN, Taffe P, Ribordy V, Schoettker P, Fishman D, Yersin B (2010) Accuracy of prehospital triage of trauma patients by emergency physicians: a retrospective study in western Switzerland. Eur J Emerg Med 19:1–18
Chisholm CD, Collison EK, Nelson DR, Cordell WH (2000) Emergency department workplace interruptions: are emergency physicians “interrupt-driven” and “multitasking”? Acad Emerg Med 7:1239–1243
Cook RI, Woods DD, Miller C (1998) A tale of two stories: contrasting views of patient safety. Report from a workshop on assembling the scientific basis for progress on patient safety. National Health Care Safety Council of the National Patient Safety Foundation at the AMA
Cooper JB, Newbower RS, Long CD, McPeek B (1978) Preventable anesthesia mishaps: a study of human factors. Anesthesiology 49:399–406
Cosby KS, Croskerry P (2009) The nature of emergency medicine. In: Croskerry P, Cosbyy KS, Schenkel SM, Wears LR (Hrsg) Patient safety in emergency medicine. Lippincott & Williams, Philadelphia
Croskerry P (2008) Cognitive and affective dispositions to respond. In: Croskerry P, Cosby KS, Schenkel SM, Wears RL (Eds) Patient safety in emergency medicine. 219–227; Lippincott Williams & Wilkins, Philadelphia
Currie M (1989) A Prospective Survey of Anaesthetic Critical Events in a Teaching Hospital. Anaesth Intensive Care 17:403–411
Dekker S (2015) Safety differently. Human factors for a new era. Taylor & Francis Group, Boca Raton
Donchin Y, Seagull FJ (2002) The hostile environment of the intensive care unit. Curr Opin Crit Care 8:316–320
Fairbanks RJ, Crittenden CN, O’Gara KG, Wilson MA, Pennington EC, Chin NP, Shah MN (2008) Emergency medical services provider perceptions of the nature of adverse events and near-misses in out-of-hospital care: an ethnographic view. Acad Emerg Med 15(12):1312–1314
Gilbert C, Amalberti R, Laroche H, Paries J (2007) Errors and failures: towards a new safety paradigm. J Risk Res 10(7):959–975
Handler JA, Gillam M, Sanders AB, Klasco R (2000) Defining, identifying, and measuring error in emergency medicine. Acad Emerg Med 7:1183–1188
Heinrichs W, Schleppers A, Birkholz T, Pierre M, Dichtjar T, Hahnenkamp C, Rohe J, Sanguino A, Thomeczek C (2013) CIRS-AINS Spezial Notfallmedizin. Anästh Intensivmed 54:97–102
Hendrie J, Sammartino L, Silvapulle M, Braitberg G (2007) Experience in adverse events detection in an emergency department: nature of events. Emerg Med Austral 19:9–15
Hohenstein C, Hempel D, Schultheis K, Lotter O, Fleischmann T (2013) Critical incident reporting in emergency medicine: results of the prehospital reports. Emerg Med J. https://doi.org/10.1136/emermed-2012-201871
Hollnagel E (2014) Safety-I and Safety-II. The past and future of safety management. Ashgate, Burlington
IOM (2006) Emergency care for children. Growing pains. Committee on the future of emergency care in the United States health system board on healthcare services. Academic, Washington
Jewell K, McGiffert L (2009) To err is human-to delay is deadly. Consumers Health Report. http://www.safepatientproject.org/2009/05/to_err_is_humanto_delay_is_dea.html
Kahneman D (2003) A perspective on judgment and choice. Mapping bounded rationality. Am Psychol 58(9):697–720
Kaufmann J, Laschat M, Wappler F (2012) Medikamentenfehler bei Kindernotfällen: Eine systematische Analyse. Dtsch Ärztebl 109(38):609–616
Kohn L, Corrigan J, Donaldson M (1999) To err is human: building a safer health system. Committee on Quality of Health Care in America, Institute of Medicine (IOM). National Academy Press, Washington DC
Leape LL, Berwick DM (2005) Five years after to err is Human: what have we learned? JAMA 19(293):2384–2390
Leape LL, Brennan TA, Laird N (1991) The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med 324:377–384
Mach E (1905) Erkenntnis und Irrtum. Skizzen zur Psychologie der Forschung. JA Barth, Leipzig
Mathews SC, Pronovost PJ (2008) Physician autonomy and informed decision making. Finding the balance for patient safety and quality. JAMA 300(24):2913–2915
Muhm M, Danko T, Madler C, Winkler H (2011) Präklinische Einschätzung der Verletzungsschwere durch Notärzte – Ansatz zur Beurteilung der Verlässlichkeit. Anaesthesist 60:534–540
Rasmussen J (1987) The definition of human error and a taxonomy for technical system design. In: Rasmussen J, Duncan K, Leplat J (Hrsg) New technology and human error. Wiley, Chichester, S 23–30
Reason J (1990) Human Error. Cambridge University Press, Cambridge
Rittenberger JC, Beck PW, Paris PM (2005) Errors of omission in the treatment of prehospital chest pain patients. Prehosp Emerg Care 9:2–7
Russ AL, Fairbanks RJ, Karsh BT, Militello LG, Saleem JJ, Wears RL (2013) The science of human factors: separating fact from fiction. BMJ Qual Saf 22(10):802–808
Sanghera IS, Franklin BD, Dhillon S (2007) The attitudes and beliefs of healthcare professionals on the causes and reporting of medication errors in a UK intensive care unit. Anaesthesia 62:53–61
Schrappe M (2018) APS-Weißbuch Patientensicherheit. Herausgegeben vom Aktionsbündnis Patientensicherheit e. V. Medizinisch Wissenschaftliche Verlagsgesellschaft, Berlin
St.Pierre M, Hofinger G, Simon R (2016) Crisis management in acute care settings. Human factors and team psychology in a high-stakes environment, Bd. 3. Springer, New York
Thomas EJ, Studdert DM, Burstin HR et al (2000) Incidence and types of adverse events and negligent patient care in Utah and Colorado. Med Care 38:261–271
Tiyyagura GK, Arnold L, Cone DC, Langhan M (2014) Pediatric anaphylaxis management in the prehospital setting. Prehosp Emerg Care 18(1):46–51
Valentin A, Capuzzo M, Guidet B, Moreno R, Metnitz B, Bauer P, Metnitz P (2009) Errors in administration of parenteral drugs in intensive care units: multinational prospective study. BMJ 338:b814
Vilke GM, Tornabene SV, Stepanski B, Shipp HE, Ray LU, Metz MA, Vroman D, Anderson M, Murrin PA Davis DP, Harley J (2007) Paramedic self-reported medication errors. Prehosp Emerg Care 11:80−84
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
Copyright information
© 2020 Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature
About this chapter
Cite this chapter
St.Pierre, M., Hofinger, G. (2020). Risikofaktor Mensch? „Human Factors“ und Patientensicherheit. In: Human Factors und Patientensicherheit in der Akutmedizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-60485-4_1
Download citation
DOI: https://doi.org/10.1007/978-3-662-60485-4_1
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-662-60484-7
Online ISBN: 978-3-662-60485-4
eBook Packages: Medicine (German Language)