Learning from our mistakes

Finding a way to safely report and learn from medical errors is always a challenge. In this issue, Hohenstein and colleagues describe a web-based critical incident reporting system that allows anonymous submission for German and Austrian out-of-hospital providers. Fifteen per cent of the reported incidents clearly affected patient outcomes (and another quarter may have). Among the incidents causing harm, almost 80% were related to staff issues, suggesting that the system may have a lot to tell us about training gaps.

Adults only

The elbow is nobody's favourite body part, but it finally gets its day in the sun. Based on results from 348 adult patients with elbow injury, Arundel et al derive a 100% sensitive (95% CI: 97% to 100%), 3-element decision rule for elbow fracture. The elements include: inability to fully extend; tenderness over the radial head, olecranon or medial epicondyle; and the presence of bruising. Validation if this adult rule is of course needed.

But it doesn't work for little ones; the performance of the adult rule for children under 16 was inadequate …