Table 1

Definition and examples of nine topics defined at the round-table discussion

TopicDefinitionExample
Diagnostic errorsErrors in diagnostics. Misdiagnosed and/or underdiagnosed patients, wrong diagnoses, errors in differential diagnoses. Insufficient medical clarification in patients with mental illnesses and vice versa.Patient is treated for depression by a psychotherapist but does not get better. During a medical consultation hypothyroidism is diagnosed. After medical treatment patient gets better.
Non-drug treatment errorsAny error that occurs in non-drug therapeutic interventions. This could be the allocation to a wrong intervention or institution or errors conducted over the course of psychotherapy.A patient aged 8 years gets psychotherapeutic treatment. Her mother, as the closest reference person, is not involved into therapeutic process.
Medication errorsAny errors that result in deviations from the ideal medication process, eg, errors of prescription, administration, confusion and unconsidered interactions between drugs. Regular side effects do not classify as medication errors.Instead of 5 mg/mL, patient is dosed with 10 mg/mL of haloperidol.
Errors related to coercive measuresAny errors that occur before, during and after the use of coercive measures. Unnecessary use of coercive measure or insufficient information and analysis of measures with patientPatient is restraint. Owing to Valium intake, she does not remember the restraint, but imprints at her wrist tell from the restraint. Staff fails to inform about restraint.
Errors related to aggression management against self and othersAny errors that occur during treatment of aggression against self and others. An error could be failure to prevent aggression against others in inpatients.Patient attacks roommate late at night without obvious reason. Patient was aggressive during the day already; however, no actions were taken.
Errors in treatment of suicidal patientsAny errors that occur during treatment of suicidal tendencies. This could be insufficient clarification/screening of suicidal tendencies or wrong or insufficient introduction of measures to prevent suicide.Patient strangles herself as a consequence of her depression. She was in her room without sufficient monitoring.
Communication errorsAny errors occurring in any form of communication between professionals and patients and relatives. Communication errors are unspecific and may occur all along the treatment pathway. Errors are insufficient patient information about treatment, alternatives, insufficient patient involvement in decision-making or lack of professional interpreters.Patient with psychotic disorder accidentally listens to a conversation between her husband and the attending physician. The doctor says: “This won't be easy. This will take time.”
Errors at interfaces of careErrors concerning any handovers and transfers of patients between or within institutions This could be lack of information at transfer or incomplete documentation in medical records.Patient on oncological ward gets also treated for a depressive episode. The episode is not documented in patient chart. As unknown to staff, depression treatment is not continued at the rehabilitation centre. Patient decompensates.
Structural errorsErrors on latent level that lead to active failures at the sharp end. Errors occur as a result of policy decisions, but are actually conducted by practitioners. Possible errors are understaffing, lack of treatment facilities for subgroups of patients (children, older adults)Owing to lack of space, a patient aged 15 years has to stay in the adult ward for crisis intervention.