classify the strategies into three groups: provider policies, provider training, and technologies. Ideally, organizations would adopt all three of these strategies. A few examples of each type are given here.

Provider Policies

One of the problems associated with reducing the incidence of medical errors is that the frequency of errors and their most important triggers are unknown. Provider initiatives aimed at raising awareness of medical errors have shown some potential, although such programs must be coupled with limits on provider liability to encourage participation. For example, one hospital created and implemented the Good Catch Reporting Program. Under this program, all staff are required to report suspected and identified medical errors and near misses without fear of reprisal. Senior hospital leadership appointed a patient safety manager who reports to the chief nurse and reviews all errors and near misses. This information is used to develop system improvements for patient safety. Within the first 3 months of the program, reporting of near misses doubled (Salisbury, 2005). This approach could also be applied to the EMS environment.

EMS and hospital administrators have a number of opportunities to examine and specifically develop policies to address areas in which they believe shortcomings in patient safety exist. One hospital created the Look Alike/Sound Alike Project, in which a second person is required to verify all medications prior to their administration to a patient. Additionally, a pharmacist separated all look alike/sound alike medications in the pharmacy and clinics. Since the project was implemented, no look alike/sound alike medication errors have been identified (Salisbury, 2005).

Provider Training

Energized by successes in the aviation industry, where teamwork training has led to reductions in errors and improved performance (Risser et al., 1999; Sprague, 1999), several organizations have promoted the concept of teamwork training for health professionals. The similarities between pilots and doctors—highly trained technically, accustomed to viewing themselves as bearers of ultimate authority and responsibility, independent yet increasingly dependent on others of varying skill levels—suggest that teamwork training may be influential in reducing errors in the medical field (Sprague, 1999). Research on the impact of teamwork training in the ED is limited but promising. MedTeams, a Department of Defense (DoD) project that introduced teamwork training to health care, developed an Emergency Team Coordination Course (ETCC), an 8-hour didactic course for physicians, nurses, technicians, and support personnel. An evaluation of the course re-



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