Becker's Clinical Quality & Infection Control

11 INFECTION CONTROL & PATIENT SAFETY Q: If a retained surgical object event does occur, how should the hospital and physicians respond? What actions should be taken? BP: e physician must tell the patient that a surgical item has been le inside him or her and then discuss the safest and best course of action for the patient. ere should be absolute transparency around the problem as soon as it is discovered. ere may be a need for further testing, and it may be possible to remove the retained surgical item quickly and with minimal morbidity. We think it is crucial that the hospital support the physician in the disclosure discussion and then, once the patient has been safely cared for, the hospital should conduct an event analysis and explore all care domains related to how and why the retained surgical item event occurred. Usually, these events point to sys- temic problems in the environment and the way in which people work, so systemwide solutions are required to enact strong prevention strategies. It is also true these events may point to individual culpability, and individual disciplinary action may be required. An analysis of the systemic reasons behind why the error in question was made — otherwise known as a just culture analysis — is a useful tool to use in the adjudication of these events. n Viewpoint: Why discrimination against female physicians threatens patient safety By Megan Knowles A fter Tokyo Medical University admitted to changing medical school admission test scores to disadvantage female applicants, healthcare leaders should know the potential patient safety threat discrimination against female physicians creates, two authors contend in a Harvard Business Review op-ed. Here are six insights from the op-ed, written by Christopher Myers, PhD, assistant professor at Balti- more-based Johns Hopkins University and Kathleen Sutcliffe, PhD, Bloomberg distinguished professor at Johns Hopkins: 1. Several studies show female physicians may pro- vide higher quality care, the authors say. One study of more than 1.5 million Medicare patients found those treated by a female physician were less likely to die or be readmitted to the hospital within 30 days than those patients with male physicians. 2. Additionally, a separate study of over 500,000 patients who experienced a sudden heart attack found any patient treated by a female physician was more likely to survive when compared to patients with a male physician. "In light of this evidence, it is reasonable to conclude that any practice, bias or treatment that keeps women from entering and advancing in medicine is actually denying patients opportunities to receive higher quality care," the authors write. 3. Although overt discrimination such as that at Tokyo Medical University is rare, potentially harmful attitudes and systemic pressures that keep female physicians from developing can be found throughout medicine, the authors say. 4. The issue of women being underrepresented in med- icine is well-documented, the authors say, with women making up more than half of medical school entrants but fewer than 35 percent of all active U.S. physicians. "This underrepresentation is driven by a range of fac- tors, from different preferences and gendered attitudes about certain medical specialties to persistent wage gaps and biases in hiring or promotion decisions," the authors write. 5. Biases that disadvantage women can be found in the clinical components of medical training, which lead to different experiences for men and women during residency training, the authors say. "For instance, having autonomy during surgical residen- cy is important for developing skills and preparing for a successful future career," the authors write. One study looked at differences in the autonomy given to male and female residents and found female surgical residents were given much less autonomy in the operat- ing room, even after adjusting for several factors related to the case. 6. The authors say barriers restricting the development of women's careers must be removed. "The field is routinely under-promoting, under-sup- porting, under-rewarding and under-training female physicians," they write. "And yet, despite these implicit and systematic barriers, female physicians continue to persist and achieve better outcomes than their male colleagues." n

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