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Table 6 Doctors

From: Increasing the options for reducing adverse events: Results from a modified Delphi technique

Proposals Effect [1 = v.high 6 = negative] mean (std dev) Implement (months) Impact (months) Total (years)
6.1 Criteria should be mandated to determine a doctor's right to perform some procedures. These should require periodic review of death rates and adverse events (inter alia). When adverse events and mortality are associated with an attribute of a practice that is known to increase risk (such as small numbers of patients, service delivery to inappropriate patients, or where clinical indicators suggest the procedure is unwarranted) review might be followed initially by advice to alter the unsafe practice or procedure and subsequently, if appropriate, by disaccreditation for that procedure. 2.00 (.73) 22 22 3.7
6.2 Centres of excellence should be established that are dedicated to certain procedures – e.g. colon cancer surgery – when it is known that the outcome of such procedures is influenced by the quality of the practice setting or the case load of the unit or doctor. 1.81 (.75) 45 18 5.3
6.3 All medical students who become interns should be 'credentialed' before they are allowed to do any unsupervised procedures (e.g. inserting nasogastric tubes). 1.94 (.77) 9 9 1.5
6.4 The supervision and support of junior doctors should be improved. 1.56 (.63) 9 7 1.3
6.5 All new graduates and all new entrants into the system (e.g. foreign graduates) should have regular performance reviews by medical educators – say, every three months. 2.20 (.68) 9 11 1.7
6.6 All hospital doctors should provide e-mail addresses so that hospitals can communicate new protocols, safety rules, etc. 2.33 (.82) 7 10 1.4