Weingart, SN. Beyond Babel, Prospects for a Universal Safety Taxonomy. Int J Qual Health Care (2005) 17 (2): 93-94
The terminology of safety is perplexing on a good day, andnear impossible on a bad one. Consider a few examples of patient safety terms in common use. An ‘adverse reaction’ usually connotes an anticipated side effect of a medication or treatment. It is similar to a ‘complication’ of care. An ‘adverse event’, in contrast, signifies the presence of a medical carerelated injury (anticipated or not). However, different users require different levels of harm in order to qualify an incident as an adverse event. A ‘preventable adverse event’ is an error by definition, but it is often difficult to ascertain preventability.
A ‘near miss’, also called a ‘close call’, is synonymous with ‘potential adverse event’ and is always considered to be preventable. A ‘sentinel event’ refers to an incident that resulted in or might have produced a serious injury. A ‘serious reportable event’ is often not reported to public authorities, its name notwithstanding. a group of senior leaders from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has outlined a new and comprehensive scheme for defining and classifying medical errors—an error taxonomy. Despite the considerable influence of the JCAHO, the widespread adoption of any universal patient safety event taxonomy faces several major hurdles. Firstly, a taxonomy’s creators must demonstrate the ‘usability’of the approach under combat conditions; the taxonomy must be easily understood and used by practitioners in a variety of settings and without extensive, costly training Secondly, the creators need to show that different users will classify the same event in the same way. Thirdly, taxonomies need to organize information in a way that yields insights into the extent and nature of medical error and opportunities for improvement. A final and most difficult challenge is one of encouraging, coercing, or seducing users into adopting a shared taxonomy.
Une critique assez directe de la complexité de la classification de la JCAHO plaidant une approche des critères que devrait avoir une bonne taxonomie des EIG pour qu’elle soit à la fois utile aux généralistes en première intention, isolement (quand le problème leur arrive, first loop) et en seconde intention, sanitaire, national, qui viserait à sommer les déclarations pour dépister des régularités, des fréquences et attaquer les causes les plus importantes.