Disclosing Medical Errors

The use of a checklist in a pediatric oncology clinic

BACKGROUND

Errors and near misses are common in medicine. Checklists and similar interventions are feasible and can reduce the incidence of errors and improve patient outcomes. This study assessed the feasibility and efficacy of a checklist in a pediatric oncology clinic.

PROCEDURE

Errors and near misses of all types were systematically tracked for 1 month in a pediatric oncology clinic. Following the initial 1 month time period (baseline), a 10-item checklist was implemented for each patient encounter during a 4-month period. During month 5 of the study while the checklist was being used, errors and near misses were again systematically tracked for 1 month.

RESULTS

The use of a checklist was associated with a significant reduction of errors in our clinic. The total number of errors (including documentation errors) decreased from 133 in month 1 to 39 in month 5 (P < 0.0001). In addition, checklist use decreased the rate of encounters with at least one error from 34% to 15% (P < 0.001). The reduction in errors occurred despite the checklist not being used for each encounter. The majority of practitioners were satisfied with the use of a checklist and think that the use of a checklist is a good way to reduce errors.

CONCLUSIONS

A checklist is potentially a feasible, safe, inexpensive, and simple method to lower the rate of medical errors in a pediatric oncology clinic.

Pediatric residents' decision-making around disclosing and reporting adverse events: the importance of social context

PURPOSE

Although experts advise disclosing medical errors to patients, individual physicians' different levels of knowledge and comfort suggest a gap between recommendations and practice. This study explored pediatric residents' knowledge and attitudes about disclosure.

METHOD

In 2006, the authors of this single-center, mixed-methods study surveyed 64 pediatric residents at the University of Toronto and then held three focus groups with a total of 24 of those residents.

RESULTS

Thirty-seven (58%) residents completed questionnaires. Most agreed that medical errors are one of the most serious problems in health care, that errors should be disclosed, and that disclosure would be difficult. When shown a scenario involving a medical error, over 90% correctly identified the error, but only 40% would definitely disclose it. Most would apologize, but far fewer would acknowledge harm if it occurred or use the word "mistake." Most had witnessed or performed a disclosure, but only 40% reported receiving teaching on disclosure. Most reported experiencing negative effects of errors, including anxiety and reduced confidence. Data from the focus groups emphasized the extent to which residents consider contextual information when making decisions around disclosure. Themes included their or their team's degree of responsibility for the error versus others, quality of team relationships, training level, existence of social boundaries, and their position within a hierarchy.

CONCLUSIONS

These findings add to the understanding of facilitators and inhibitors of error disclosure and reporting. The influence of social context warrants further study and should be considered in medical curriculum design and hospital guideline implementation.