PrepTest 148, Section 1, Question 11

What we’re looking for

Working the answers

• A

  This describes an existing policy for a narrower category of error: those causing life-threatening injuries. The new plan covers errors causing patient injuries more generally. Knowing the older policy existed doesn't show that awareness of the new monitoring caused the recent improvement, or tell us whether some other change did.

• B

  A decrease at a hospital without the plan suggests an alternative explanation worth considering. Perhaps a broader change affected patient care across the region. This doesn't prove the plan had no effect, but it gives us less reason to attribute the participating hospitals' improvement specifically to awareness of monitoring.

• C

  This tells us that errors causing no injury weren't recorded. The result we're explaining is a decline in injuries, and the argument attributes that decline to greater care prompted by monitoring. Excluding near misses from the records doesn't establish that this proposed change in staff behavior occurred.

• D
  Correct

  The timing lines up with the proposed cause at each hospital. Injuries didn't start decreasing until staff knew the records were being closely analyzed. That is more helpful than simply knowing a recordkeeping plan existed: it links the improvement to staff becoming aware of scrutiny. Other explanations remain possible, but this pattern strengthens the claim that awareness made people more careful.

• E

  A reprimand could matter to some staff, while others might regard it as a light consequence. We aren't told how staff responded or whether the warning policy explains the decline. The mere fact that first errors received reprimands is much less direct evidence of the proposed behavior change than D's timing connection.