Root Cause Analysis (RCA): an opportunity for hospital librarians to provide value added service, presented by Kathy Fatkin of the Eastern Idaho Regional Medical Center Health Sciences Library.
September 17, 2014 at 1 PM Pacific (noon Alaska 2 PM Mountain)
Root cause analysis is a method for evaluating the big picture as well as the details of a serious error or a near miss to provide hospitals with an understanding of how and why an error occurred and how it might be avoided in the future. The main objective of the RCA is to take action to address the underlying causes of the error. One component of the RCA is a literature review. The medical librarian can provide a literature search and gather the appropriate articles to provide information necessary to identify causes of errors and the corrective actions that reduce the likelihood of the error happening again. By using a standardized format to evaluate the literature collected the librarian can provide the RCA team with a summary of the literature that includes a statement to answer the clinical questions that the incident generated which saves the team time and allows them to focus attention on the local factors that contributed to the error. Involving the librarian early in the process before the team meets ensures the information they need is available when they determine an action plan to address the problems they identify. (more…)