Contextual errors and failures in individualizing patient care: a multicenter study.

Background: A contextual error occurs when a physician overlooks elements of a patient's environment or behavior that are essential to planning appropriate care. In contrast to biomedical errors, which are not patient-specific, contextual errors represent a failure to individualize care.

Objective: To explore the frequency and circumstances under which physicians probe contextual and biomedical red flags and avoid treatment error by incorporating what they learn from these probes.

Managing the unmanaged: a case study of intra-institutional determinants of uncompensated care at healthcare institutions with differing ownership models.

Study Objective: This study presents a case analysis of how 3 urban medical centers with differing ownership models, within 1 metropolitan area, ration access to uncompensated care to uninsured patients.

Methods: Data was triangulated from 3 sources: hospital financial reports by service line for a fiscal year, a survey of 292 self-pay patients, and the self-pay policies and practices of clerical personnel described in a previous publication.

Results: Although the public, for-profit and not-for-profit institutions used different strategies for managing self-pays, there were also commonalities in the experiences indigent patients reported.

Avoiding free care at all costs: a survey of uninsured patients choosing not to seek emergency services at an urban county hospital.

The purpose of this case study was to understand why many uninsured patients opt not to make use of a free public hospital when it is available, instead seeking emergency department care at sites where they will be billed for the services they receive. One hundred fifty seven uninsured patients were interviewed over an 8-week period at three emergency departments that bill for services near a county hospital that provides free care. Data was gathered on income, health status, and credit history.

Rationing access to care to the medically uninsured: the role of bureaucratic front-line discretion at large healthcare institutions.

Background: Medically uninsured patients seeking nonemergency care are not guaranteed access to services at most healthcare institutions. They must first register with a clerk who could require a deposit and/or payment on an outstanding debt.

Objectives: This study examines the factors that influence whether nonmedical bureaucratic staff sign in or turn away uninsured patients who cannot meet prepayment requirements.

A model of medical error based on a model of disease: interactions between adverse events, failures, and their errors.

This article discusses Rush-Presbyterian-St. Luke's Medical Center's approach to assessing and preventing errors in care and promoting patient safety. The word error is applied to all kinds of events, including adverse occurrences, negligence, and malpractice.