TUESDAY, AUGUST 13
Confidential Incident Reporting and Human Error in
The U.S. Institute of Medicine estimates that medical errors
result in about 45,000-100,000 deaths each year. This compares with
43,000 road traffic accident deaths. The medical treatment for
patients who suffer these "adverse medical events" costs about $15
billion. According to Chris Johnson at the University of Glasgow in
Scotland, these statistics hide the personal stories of patients
and their relatives who must come to terms with the consequences of
their treatment rather than their illness.
Johnson, Professor of Computing Science, University of Glasgow,
Scotland, will speak on "Evaluating the Effectiveness of Incident
Reporting Systems" at a colloquium at 2 p.m., Tuesday, August 13,
at NASA Langley's H.J.E. Reid Conference Center.
Media Briefing: A media briefing will be held
at 1:15 p.m. at the H.J.E. Reid Conference Center, 14 Langley
Blvd., at NASA Langley Research Center. Members of the media who
wish to attend should contact Kimberly W. Land at (757) 864-9885
Confidential incident reporting systems have been widely
proposed as a means of eliciting information about previous
failures. Via such systems, nurses and doctors submit reports about
incidents or "near misses" without blame or retribution.
Johnson will describe a range of techniques that have been
developed and applied to help monitor incident reporting systems in
the rail, aviation, and healthcare industries in the United
Kingdom. He will also give an overview of the incidents reported in
UK and US systems, and will conclude the talk with a description of
the limitations of existing reporting schemes, by introducing a
range of techniques that address these problems.
At the University of Glasgow, Johnson heads a research group
that focuses on the investigation and reporting of technological
failure in safety critical systems. He has master degrees from the
Universities of Cambridge and York.
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