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Richard RD, Pesante BD, Parry JA, Mauffrey C. The Effect of Adverse Events on Orthopaedic Surgeons: A Review. J Am Acad Orthop Surg 2024; 32:771-776. [PMID: 39019003 DOI: 10.5435/jaaos-d-23-01205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/16/2024] [Indexed: 07/19/2024] Open
Abstract
The purpose of this review was to evaluate the effect of adverse events (AEs) on orthopaedic surgeons, illustrate common ways orthopaedic surgeons deal with AEs, and describe solutions to reduce the negative effect of AEs and prevent them from recurring. AEs are common in orthopaedic surgery and increase the risk of depression, anxiety, and suicide. Orthopaedic surgeons may experience negative effects after AEs even when they are not at fault. AEs are linked to moral injury, second victim syndrome, burnout, and disruptive physician behaviors. Many surgeons deal with AEs in isolation out of fear of a negative effect on their professional reputation, potentially leading to increased psychological distress and unhealthy coping mechanisms. Healthy ways to address AEs and improve the well-being of surgeons include destigmatizing psychological stress after AEs and creating a culture of receptivity and peer support.
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Affiliation(s)
- Raveesh D Richard
- From the Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO
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Conway AE, Rupprecht C, Bansal P, Yuan I, Wang Z, Shaker MS, Verdi M, Bradley J. Leveraging learning systems to improve quality and patient safety in allergen immunotherapy. Ann Allergy Asthma Immunol 2024; 132:694-702. [PMID: 38484839 DOI: 10.1016/j.anai.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/04/2024] [Accepted: 03/04/2024] [Indexed: 06/07/2024]
Abstract
Adverse events occur in all fields of medicine, including allergy-immunology, in which allergen immunotherapy medical errors can cause significant harm. Although difficult to experience, such errors constitute opportunities for improvement. Identifying system vulnerabilities can allow resolution of latent errors before they become active problems. We review key aspects and frameworks of the medical error response, acknowledging the fundamental responsibility of clinical teams to learn from harm. Adverse event response comprises 4 major phases: (1) event recognition and reporting, (2) investigation (for which root cause analysis can be helpful), (3) improvement (inclusive of the plan-do-study-act cycle), and (4) communication and resolution. Throughout the process, clinician wellness must be maintained. Adverse event prevention should be prioritized, and a human factors engineering approach can be useful. Quality improvement tools and approaches complement one another and together offer a meaningful avenue for error recovery and prevention.
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Affiliation(s)
| | - Chase Rupprecht
- Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Priya Bansal
- Asthma and Allergy Wellness Center, St Charles, Illinois; Northwestern Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Irene Yuan
- Section of Allergy and Clinical Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ziwei Wang
- Section of Allergy and Immunology, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California
| | - Marcus S Shaker
- Departments of Medicine and Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
| | - Marylee Verdi
- Dartmouth College Student Health, Hanover, New Hampshire
| | - Joel Bradley
- Departments of Medicine and Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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3
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Harris CK, Darrell CM, VanderLaan PA, Heher YK. Patient-facing communication for cytopathologists: A framework for disclosing diagnostic error. Cancer Cytopathol 2023; 131:10-18. [PMID: 35904882 DOI: 10.1002/cncy.22627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 01/04/2023]
Abstract
Medical errors are a major source of harm to patients. Regulatory bodies mandate and patient safety experts advocate the disclosure of medical errors to patients to promote transparency and to create accountability for improving health care processes. Although pathologists regularly report errors-either to pathology or clinical colleagues or via internal safety reporting systems-few pathologists directly disclose those errors to patients. Yet many pathologists are interested in participating in the direct disclosure of medical errors to patients and may even be mandated to do so. When surveyed on why they do not directly disclose errors to patients, pathologists commonly cite a lack of confidence and a lack of training. Another barrier cited is the lack of a preexisting relationship between the pathologist and the patient. With respect to this last barrier, cytopathologists have a distinct advantage over surgical or clinical pathologists, as many cytopathologists regularly interact with and develop a rapport with patients when they are performing fine-needle aspiration (FNA) procedures. To improve the safety culture in pathology, direct error disclosure practices must be developed, supported, and strengthened. It is critical for cytopathologists to be comfortable with disclosing errors to patients. Being comfortable with disclosing an error, however, requires training, practice, and advance reflection. Using a practical, case-based format centered around FNA examples, this article addresses how to disclose a medical error to a patient. It provides a framework, heuristic principles, and structured conversation systems and talking points to guide the inexperienced pathologist to find his or her voice in a challenging disclosure conversation.
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Affiliation(s)
- Cynthia K Harris
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Caitlin M Darrell
- Department of Pathology, Advocate Health Care, Oak Lawn, Illinois, USA
| | - Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Yael K Heher
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Why Are Patients Unhappy with Their Healthcare? A Romanian Physicians’ Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159460. [PMID: 35954821 PMCID: PMC9368265 DOI: 10.3390/ijerph19159460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/29/2022] [Accepted: 07/29/2022] [Indexed: 12/10/2022]
Abstract
Background: Medical professional liability complaints are not triggered by a single factor, but rather by multiple factors, each having more or less implications, such as the characteristics of the physician, the medical system, the patients, the complexity of their pathology, and the inherent limits of medicine. Knowledge about the factors that initiate the complaint procedure is essential to identify the targeted measures to limit their prevalence and impact. The purpose of this study was to identify the reasons behind the malpractice complaints and the factors that may influence the initiation of complaints by the patients. Material and Methods: This study was conducted using an online questionnaire, addressed to Romanian doctors, with questions about the reasons for patient dissatisfaction and complaints, the factors that predispose a physician to being complained against, and the protective factors against patient complaints. Results: The study group included 1684 physicians, of whom 16.1% were themselves involved in a complaint, and 52.5% knew of a colleague who was complained against. The opinions of the participants regarding the reasons for the complaints, the predisposing factors to complaints, and the factors that contributed to the reported incident showed a strong link between professional liability complaints and the physician–patient/patient’s family relationship. The relationship between fellow physicians is additional to this. Conclusion: This study reveals that the improvement in the relational aspects of medical practice (physician–patient relationship and relationship between physicians) has the highest potential to decrease the number of malpractice complaints. Its practical relevance is related to the need for training physicians in the relational aspects of medical practice during academic years and throughout their career.
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Barsky M, Olson APJ, Astik GJ. Classifying and Disclosing Medical Errors. Med Clin North Am 2022; 106:675-687. [PMID: 35725233 DOI: 10.1016/j.mcna.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Medical errors are an unfortunate but common occurrence in health care. It is important to understand what medical errors are and what types of harm can occur to patients. Along with recognition of the error, disclosure is an equally important part of the process. Clinicians should provide open and honest discussion about the events that occurred to patients along with feedback to institutions on ways to prevent such errors in the future.
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Affiliation(s)
- Maria Barsky
- Hospitalist Program, UC Irvine Medical Center, 101 The City Drive South, Suite 500, Orange, CA 92868, USA.
| | - Andrew P J Olson
- Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine, , University of Minnesota Medical School, 420 Delaware Street Southeast, MMC 741, Minneapolis, MN 55455, USA; Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Minnesota Medical School, 420 Delaware Street Southeast, MMC 741, Minneapolis, MN 55455, USA. https://twitter.com/@andrewolsonmd
| | - Gopi J Astik
- Division of Hospital Medicine, Northwestern University Feinberg School of Medicine, 251 East Huron Street Suite 16-738, Chicago, IL 60611, USA. https://twitter.com/@gopiastik
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Ortiz-López N, Ponce-Arancibia S, Olea-Gangas C, Chacano-Muñoz R, Arancibia-Carvajal S, Solis I. Determinants of the intention to speak up about medical error in primary healthcare settings in Chile. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1202-e1211. [PMID: 34431150 DOI: 10.1111/hsc.13527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 06/29/2021] [Accepted: 07/21/2021] [Indexed: 06/13/2023]
Abstract
Medical error frequently occurs in ambulatory care, and healthcare professionals may encounter situations in which they need to speak up to ensure better practice. This study aims to investigate the factors that influenced the intention to speak up about medical errors among healthcare professionals in primary care settings. Data were generated through a national cross-sectional survey of primary healthcare centres in the Republic of Chile. A research instrument was designed using the constructs of the theory of planned behaviour and was analysed using the structural equation model technique. In total, 203 healthcare professionals were recruited between March and May 2020. The model showed that the intention to speak up was directly and positively influenced by attitudes towards speaking up and perceived control (standard deviation [SD] = 0.284 and 0.576, respectively). Subjective norms indirectly and negatively influenced the intention to speak up through attitudes towards speaking up and perceived control (total effect SD = -0.303). The exploratory construct of willingness to change self-behaviour positively influenced the attitude towards behaviour. The intention to speak up strongly influenced the speaking up behaviour (total effect SD = 0.631). The proposed model explained 40% of the variance in behaviour. Based on this model, it was concluded that the intention to speak up strongly influenced the speaking up behaviour and predicted it by 40%. Factors that modify the intention to speak up are expected to influence the occurrence of this behaviour. This knowledge will inform strategies to enhance communication among healthcare professionals, improve speaking up behaviour and improve patient care.
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Affiliation(s)
| | | | | | | | - Sara Arancibia-Carvajal
- Institute of Basic Sciences, Faculty of Engineering and Sciences, Diego Portales University, Santiago, Chile
| | - Ivan Solis
- University of Chile School of Medicine, Santiago, Chile
- Department of Medicine, University of Chile Clinical Hospital, Santiago, Chile
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Aubin J, Rivolet O, Taunay AL, Ragot S, Ghazali DA, Oriot D. Benefit of Simulation-Based Training in Medical Adverse Events Disclosure in Pediatrics. Pediatr Emerg Care 2022; 38:e622-e627. [PMID: 34398860 DOI: 10.1097/pec.0000000000002454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Adverse events (AEs) in health care are a public health issue. Although mandatory, error disclosure is experienced by health providers as a difficult task. METHODS In this prospective study, the primary objective was to assess performance in disclosing AEs to simulated parents using a validated scale before and after training among a pediatric residents' population. Secondary objectives were to assess correlation with year of residency, sex, and previous experience and to analyze gain in knowledge (theoretical pretest/posttest scores) and satisfaction. Two evaluation simulations (simulation [SIM] 1 and SIM 2) were scheduled at 3-week interval. In the intervention group, mastery learning was offered after SIM 1 including a didactic approach and a training session using role-playing games. For the control group, the course was carried out after SIM 2. Assessments were performed by 2 independent observers and simulated parents. RESULTS Forty-nine pediatric residents performed 2 scenarios of AE disclosure in front of simulated parents. In the intervention group, performance scores on SIM 2 (72.36 ± 5.40) were higher than on SIM 1 (65.08 ± 9.89, P = 0.02). In the control group, there was no difference between SIM 1 and SIM 2 (P = 0.62). The subjective scores from simulated parents showed the same increase on SIM 2 (P < 0.01). There was no correlation with the residents' previous experience or their residency year. There was an increase in self-confidence (P = 0.04) for SIM 2. There was also an increase in posttest theoretical scores (P = 0.02), and residents were satisfied with the training. CONCLUSIONS This study showed the benefits of simulation-based training associated with mastery learning in AE disclosure among pediatric residents. It is important to train residents for these situations to avoid traumatic disclosure generating a loss of confidence of the family regarding physicians and possible lawsuits.
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Affiliation(s)
| | | | | | - Stéphanie Ragot
- Statistical Department and Clinical Investigation Center (CIC 1402), INSERM (French National Health and Medical Research Institute), University Hospital of Poitiers
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Shapiro J, Robins L, Galowitz P, Gallagher TH, Bell S. Disclosure Coaching: An Ask-Tell-Ask Model to Support Clinicians in Disclosure Conversations. J Patient Saf 2021; 17:e1364-e1370. [PMID: 29781980 DOI: 10.1097/pts.0000000000000491] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Error disclosure is a high-stakes, emotionally charged interaction for patients and families as well as clinicians. A failed disclosure can result in emotional distress, reduced patient and family trust, litigation, and lost opportunities to learn from and prevent subsequent errors. However, many clinicians have little expertise in handling these challenging interactions and can inadvertently make a bad situation worse. Even those clinicians who have had formal disclosure training may have trouble remembering what they were taught when faced with the need to actually discuss an error with patients. Providing just-in-time coaching to clinicians is recommended by national standards. However, there is scant training material to guide error disclosure coaches. Therefore, we developed an "Ask-Tell-Ask" model and materials to guide the disclosure coaching process. The Ask-Tell-Ask model is well-suited to provide clinicians with targeted interactive teaching immediately before a disclosure without overwhelming them with lecture-style facts that they are unlikely to retain. Such teaching would ideally be provided by trained disclosure coaches, available for just-in-time support of clinicians throughout the disclosure process. The Ask-Tell-Ask model can also help risk managers, department heads, clinical managers, attending physicians, service chiefs, and others who assist clinicians with error disclosure. Here, we describe a comprehensive approach to coaching developed over years of coaching experience that incorporates the model, its rationale, step-by-step coaching strategies and guidance (including sample scripts), and organizational considerations regarding implementation of a coaching program to support patient-centered transparent communication after harmful events.
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Affiliation(s)
- Jo Shapiro
- From the Brigham and Women's Hospital Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Sigall Bell
- Beth Israel Deaconess Medical Center Harvard Medical School, Boston, Massachusetts
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Duffy B, Miller J, Vitous CA, Dossett LA. Intersystem Medical Error Discovery: A Document Analysis of Ethical Guidelines. J Patient Saf 2021; 17:e1765-e1773. [PMID: 32168281 PMCID: PMC7483979 DOI: 10.1097/pts.0000000000000625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Patient safety programs aim to improve transparency regarding medical errors, and there is broad consensus on how providers should communicate about their own errors. How providers should respond to other providers' errors is less clear, especially when they occur outside the provider's facility or system (intersystem medical error discovery [IMED]). To understand what guidance is available to healthcare professionals in this scenario, we conducted a document analysis of ethical guidelines. METHODS We searched for ethics codes primarily using databases and lists of professional associations. We used thematic analysis to examine documents in relation to our research questions: is there guidance on (a) what a provider should do after discovering another provider's error that occurred in a different health system, (b) interacting with other providers, or (c) other subjects relevant to IMED? RESULTS Our search identified 150 documents from 120 organizations. These documents contained ambiguous terminology and guidance limiting practical application to IMED scenarios, with most guidance potentially applicable to IMED rendered irrelevant to most IMED scenarios by its restriction to incompetence. In addition, guidelines often sent conflicting signals about prioritizing honesty with and autonomy of patients versus not criticizing the care provided by a fellow practitioner. CONCLUSIONS Ethics codes provide little guidance on communication regarding IMED scenarios, and in some cases, the guidance is internally conflicting. National professional and patient safety organizations should work to provide a framework for providers and facilities to communicate regarding these ethically and professionally challenging scenarios.
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Affiliation(s)
- Blake Duffy
- From the Medical School, University of Michigan
| | | | - C Ann Vitous
- Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, Michigan
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Lam BD, Bourgeois F, Dong ZJ, Bell SK. Speaking up about patient-perceived serious visit note errors: Patient and family experiences and recommendations. J Am Med Inform Assoc 2021; 28:685-694. [PMID: 33367831 DOI: 10.1093/jamia/ocaa293] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/27/2020] [Accepted: 11/15/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Open notes invite patients and families to read ambulatory visit notes through the patient portal. Little is known about the extent to which they identify and speak up about perceived errors. Understanding the barriers to speaking up can inform quality improvements. OBJECTIVE To describe patient and family attitudes, experiences, and barriers related to speaking up about perceived serious note errors. METHODS Mixed method analysis of a 2016 electronic survey of patients and families at 2 northeast US academic medical centers. Participants had active patient portal accounts and at least 1 note available in the preceding 12 months. RESULTS 6913 adult patients (response rate 28%) and 3672 pediatric families (response rate 17%) completed the survey. In total, 8724/9392 (93%) agreed that reporting mistakes improves patient safety. Among 8648 participants who read a note, 1434 (17%) perceived ≥1 mistake. 627/1434 (44%) reported the mistake was serious and 342/627 (56%) contacted their provider. Participants who self-identified as Black or African American, Asian, "other," or "multiple" race(s) (OR 0.50; 95% CI (0.26,0.97)) or those who reported poorer health (OR 0.58; 95% CI (0.37,0.90)) were each less likely to speak up than white or healthier respondents, respectively. The most common barriers to speaking up were not knowing how to report a mistake (61%) and avoiding perception as a "troublemaker" (34%). Qualitative analysis of 476 free-text suggestions revealed practical recommendations and proposed innovations for partnering with patients and families. CONCLUSIONS About half of patients and families who perceived a serious mistake in their notes reported it. Identified barriers demonstrate modifiable issues such as establishing clear mechanisms for reporting and more challenging issues such as creating a supportive culture. Respondents offered new ideas for engaging patients and families in improving note accuracy.
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Affiliation(s)
- Barbara D Lam
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Fabienne Bourgeois
- Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Zhiyong J Dong
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Sigall K Bell
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Loren DL, Lyerly AD, Lipira L, Ottosen M, Namey E, Benedetti T, Dunlap BS, Thomas EJ, Prouty C, Gallagher TH. Communication regarding adverse neonatal birth events: Experiences of parents and clinicians. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2021. [DOI: 10.1177/25160435211017749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Communicating with parents about adverse birth outcomes is challenging. We sought to describe attitudes and experiences of parents and providers regarding communication about adverse newborn birth events. Methods From 2011–2012, we conducted semi-structured in-depth interviews with parents who believed they had experienced an adverse birth-related neonatal outcome and focus groups with healthcare providers who have communicated with parents about adverse newborn birth events from three geographically diverse US academic medical centers. We conducted qualitative thematic analysis to identify key themes. Results Parents and providers described unique communication challenges around adverse neonatal outcomes in six categories: 1) High expectations for a positive delivery experience and the view that birth is a life event, not a medical encounter; 2) Powerful emotions associated with birth, amplified when an adverse event occurs; 3) Rapid changes when expectations for a normal birth take a sudden negative turn; 4) Family involvement adding complexity to communication; 5) Multiple patients and providers complicating communication dynamics with inter-professional teams seeking to coordinate information and care; and, 6) Concerns about litigation surrounding the birth experience. Strategies to educate parents and enhance communication were identified by both parents and providers. Conclusion Both parents and providers experience – and may suffer as a result of – communication challenges following adverse birth events affecting the newborn. Training and resources for this care environment are needed to meet parental, extended family, and provider expectations for communication when these events occur.
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Affiliation(s)
- Davia Liba Loren
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Anne Drapkin Lyerly
- Department of Social Medicine and Center for Bioethics, University of North Carolina at Chapel Hill, NC, USA
| | - Lauren Lipira
- Department of Health Services, University of Washington School of Medicine, Seattle, WA, USA
| | - Madelene Ottosen
- University of Texas Health Science Center at Houston, UT-MH Center for Healthcare Quality and Safety, Houston, TX, USA
| | - Emily Namey
- Behavioral, Epidemiological, and Clinical Sciences, FHI 360, Durham, NC, USA
| | - Thomas Benedetti
- Department of Obstetrics & Gynecology, University of Washington School of Medicine, Seattle, WA, USA
| | - Benjamin S Dunlap
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Eric J Thomas
- McGovern Medical School, The University of Texas at Houston – Memorial Hermann Center for Healthcare Quality and Safety, Houston, TX, USA
| | - Carolyn Prouty
- Public Health and Health Sciences, The Evergreen State College, Seattle, WA, USA
| | - Thomas H Gallagher
- Department of Medicine and Department of Bioethics & Humanities, University of Washington School of Medicine, Seattle, WA, USA
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Antunez AG, Saari A, Miller J, Dossett LA. Patient Preferences in Cases of Inter-system Medical Error Discovery (IMED). Ann Surg 2021; 273:516-522. [PMID: 31348037 PMCID: PMC9535472 DOI: 10.1097/sla.0000000000003507] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE This study analyzes patients' preferences around disclosure in cases of IMED. BACKGROUND Patients prefer that physicians disclose their self-discovered medical errors, and disclosure expectations and practices have changed accordingly. Patient preferences about disclosure when physicians discover another provider's error are unknown. METHODS We conducted telephone interviews beyond thematic saturation (N = 30) from January to March 2018 with patient volunteers in Michigan. Participants responded to 2 medical error vignettes, the first involving a single physician discovering their own error, and the second involving an IMED scenario. Interviews were conducted concurrently with thematic coding, coded independently by 2 investigators, and discussed until consensus was reached. Analysis proceeded after the inductive and comparative approach of interpretive description. RESULTS Patients considered IMED essentially equivalent to self-discovered errors, and strongly preferred disclosure in both scenarios. Patients preferred disclosure for a variety of reasons, most commonly describing an inherent value in knowing about their own health, a belief that physicians should practice honesty and transparency, and a desire to participate in future care in an informed manner. Patients said they would likely take certain actions after disclosure of another physician's error, ranging from confronting the responsible physician to changing providers to pursuing legal action, with the latter being only in cases of irreversible and debilitating errors. CONCLUSIONS This study explores a new domain within the field of error disclosure, concluding that patients preferred disclosure of errors in cases of IMED. Overall, these findings provide motivation to devise systems-level solutions to enable and facilitate IMED disclosure.
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Affiliation(s)
- Alexis G Antunez
- Center for Health Outcomes and Policy (CHOP)
- University of Michigan Medical School
| | - Annaka Saari
- University of Michigan College of Literature, Science, and The Arts
| | | | - Lesly A Dossett
- Center for Health Outcomes and Policy (CHOP)
- University of Michigan Department of Surgery, Ann Arbor, Michigan
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Abstract
OBJECTIVES To provide preliminary estimates of incident disclosure behaviors on medical malpractice claims. METHODS We conducted a descriptive analysis of data on medical malpractice claims obtained from the Controlled Risk Insurance Company and Risk Management Foundation of Harvard Medical Institutions (Cambridge, Massachusetts) between 2012 and 2013 (n = 434). The characteristics of disclosure and apology after medical errors were analyzed. RESULTS Of 434 medical malpractice claims, 4.6% (n = 20) medical errors had been disclosed to the patient at the time of the error, and 5.9% (n = 26) had been followed by disclosure and apology. The highest number of disclosed injuries occurred in 2011 (23.9%; n = 11) and 2012 (34.8%; n = 16). There was no incremental increase during the financial years studied (2012-2013). The mean age of informed patients was 52.96 years, 58.7 % of the patients were female, and 52.2% were inpatients. Of the disclosed errors, 26.1% led to an adverse reaction, and 17.4% were fatal. The cause of disclosed medical error was improper surgical performance in 17.4% (95% confidence interval, 6.4-28.4). Disclosed medical errors were classified as medium severity in 67.4%. No apology statement was issued in 54.5% of medical errors classified as high severity. CONCLUSIONS At the health-care centers studied, when a claim followed a medical error, providers infrequently disclosed medical errors or apologized to the patient or relatives. Most of the medical errors followed by disclosure and apology were classified as being of high and medium severity. No changes were detected in the volume of lawsuits over time.
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Smith C, Crowley A, Munsie M, DeMartino ES, Staff NP, Shapiro S, Master Z. Academic physician specialists' views toward the unproven stem cell intervention industry: areas of common ground and divergence. Cytotherapy 2021; 23:348-356. [PMID: 33563545 DOI: 10.1016/j.jcyt.2020.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 12/27/2020] [Accepted: 12/29/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND AIMS Premature commercialization of unproven stem cell interventions (SCIs) has received significant attention within the regenerative medicine community. Patients considering SCIs may encounter misinformation and seek out guidance from their physicians who are trusted brokers of health information. However, little is known about the perspectives of academic physician specialists toward the SCI industry. The purpose of this study was to capture the attitudes of physician specialists with experience addressing patient questions about unproven SCIs. METHODS The authors undertook 25 semi-structured interviews with academic physicians in cardiology, ophthalmology, orthopedics, pulmonology and neurology primarily from one academic center. RESULTS The authors identified two major themes: concerns and mediators of appropriateness of offering SCIs as therapies to patients. Specialists were generally aware of the industry and reported scientific and commercial concerns, including the scientific uncertainty of SCIs, medical harms to patients, misleading marketing and its impact on patient informed consent and economic harms due to large out-of-pocket costs for patients. All specialists outside of orthopedics voiced that it was inappropriate to be offering SCIs to patients today. These views were informed by previously expressed concerns surrounding safety and properly informing patients, levels of evidence needed prior to offering SCIs therapeutically and desired qualifications for clinicians. Among the specialties, orthopedists reported that under certain conditions, SCIs may be appropriate for patients with limited clinical options but only when safety is adequate, expectations are managed and patients are well informed about the risks and chances of benefit. Most participants expressed a desire for phase 3 studies and Food and Drug Administration approval prior to marketing SCIs, but some also shared the challenges associated with upholding these thresholds of evidence, especially when caring for out-of-option patients. CONCLUSIONS The authors' results suggest that medical specialists are aware of the industry and express several concerns surrounding SCIs but differ in their views on the appropriateness and clinical evidence necessary for offering SCIs currently to patients. Additional educational tools may help physicians with patient engagement and expectation management surrounding SCIs.
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Affiliation(s)
- Cambray Smith
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA; University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Aidan Crowley
- Department of Biological Sciences, College of Science, University of Notre Dame, Notre Dame, Indiana, USA
| | - Megan Munsie
- Department of Anatomy and Neuroscience, Centre for Stem Cell Systems, University of Melbourne, Parkville, Australia
| | - Erin S DeMartino
- Division of Pulmonary and Critical Care Medicine and Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Nathan P Staff
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Shane Shapiro
- Department of Orthopedic Surgery and Center for Regenerative Medicine, Mayo Clinic College of Medicine, Jacksonville, Florida, USA
| | - Zubin Master
- Biomedical Ethics Research Program and Center for Regenerative Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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15
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Miller J, Vitous CA, Boothman RC, Dossett LA. Medical error professionals' perspectives on Inter-system Medical Error Discovery (IMED): Consensus, divergence, and uncertainty. Medicine (Baltimore) 2020; 99:e21425. [PMID: 32756147 PMCID: PMC7402729 DOI: 10.1097/md.0000000000021425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 06/02/2020] [Accepted: 06/24/2020] [Indexed: 11/25/2022] Open
Abstract
Best practices for how to respond are unclear when a medical error is discovered in a different system (inter-system medical error discovery or IMED). This qualitative study explored medical error professionals' views on disclosure, feedback, and reporting in these scenarios.We conducted semi-structured telephone interviews from January to September 2018 with 15 medical error professionals from 5 regions of the United States. Interview guides addressed perspectives on best practice, minimum obligations, and mediating factors with respect to IMED. Each transcript was coded independently by two investigators. Analysis followed the inductive approach of interpretive description.Medical error professionals expressed diverse views about minimum obligations and best practices for physicians when responding to IMED events. All cited practical barriers to disclosure, feedback, and reporting in these scenarios. There was general consensus that clear-cut, harmful errors should be disclosed to patients, and most advised investigation and feedback prior to disclosure. Respondents diverged in recommended best practices and thresholds for taking action. All noted the lack of guidance specific to IMED scenarios but differed in how they would extrapolate from more general guidance.While medical error professionals expressed consensus regarding obligations to disclose obvious errors, they differed on particulars. Guidelines or an algorithm could be very useful. Efforts to develop clear guidelines for IMED must take into account these factors, as well as practical and political challenges to communication about errors discovered across systems.
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Affiliation(s)
- Jacquelyn Miller
- Center for Bioethics and Social Sciences in Medicine (CBSSM)
- Center for Healthcare Outcomes and Policy (CHOP)
| | | | | | - Lesly A. Dossett
- Center for Bioethics and Social Sciences in Medicine (CBSSM)
- Center for Healthcare Outcomes and Policy (CHOP)
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
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16
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Mello MM, Jagsi R. Standing Up against Gender Bias and Harassment - A Matter of Professional Ethics. N Engl J Med 2020; 382:1385-1387. [PMID: 32268023 DOI: 10.1056/nejmp1915351] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Michelle M Mello
- From Stanford Law School and the Department of Medicine, Stanford University School of Medicine, Stanford, CA (M.M.M.); and the Department of Radiation Oncology and the Center for Bioethics and Social Sciences, University of Michigan Medical School, Ann Arbor (R.J.)
| | - Reshma Jagsi
- From Stanford Law School and the Department of Medicine, Stanford University School of Medicine, Stanford, CA (M.M.M.); and the Department of Radiation Oncology and the Center for Bioethics and Social Sciences, University of Michigan Medical School, Ann Arbor (R.J.)
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17
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Stephens AL, Bruce CR, Childress A, Malek J. Why Families Get Angry: Practical Strategies for Clinical Ethics Consultants to Rebuild Trust Between Angry Families and Clinicians in the Critical Care Environment. HEC Forum 2020; 31:201-217. [PMID: 30820819 DOI: 10.1007/s10730-019-09370-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Developing a care plan in a critical care context can be challenging when the therapeutic alliance between clinicians and families is compromised by anger. When these cases occur, clinicians often turn to clinical ethics consultants to assist them with repairing this alliance before further damage can occur. This paper describes five different reasons family members may feel and express anger and offers concrete strategies for clinical ethics consultants to use when working with angry families acting as surrogate decision makers for critical care patients. We reviewed records of consults using thematic analysis between January 2015 and June 2016. Each case was coded to identify whether the case involved a negative encounter with an angry family. In our review, we selected 11 cases with at least one of the following concerns or reasons for anger: (1) perceived or actual medical error, (2) concerns about the medical team's competence, (3) miscommunication, (4) perceived conflict of interest or commitment, or (5) loss of control. To successfully implement these strategies, clinical ethics consultants, members of the medical team, and family members should share responsibility for creating a mutually respectful relationship.
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Affiliation(s)
| | - Courtenay R Bruce
- The Methodist Hospital System, System Quality and Patient Safety, Houston, TX, USA
| | - Andrew Childress
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 301D, Houston, TX, 77030, USA
| | - Janet Malek
- Center for Medical Ethics & Health Policy, Baylor College of Medicine, One Baylor Plaza, Suite 301D, Houston, TX, 77030, USA.
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18
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Whicher DM, Wu AW. Collateral Findings from Pragmatic Clinical Trials: What Responsibility Do We Have to Enrolled and Future Patients? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:21-24. [PMID: 31896336 DOI: 10.1080/15265161.2019.1687790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | - Albert W Wu
- Johns Hopkins Bloomberg School of Public Health
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19
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Morain SR, Weinfurt K, Bollinger J, Geller G, Mathews DJ, Sugarman J. Ethics and Collateral Findings in Pragmatic Clinical Trials. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:6-18. [PMID: 31896322 PMCID: PMC7027922 DOI: 10.1080/15265161.2020.1689031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Pragmatic clinical trials (PCTs) offer important benefits, such as generating evidence that is suited to inform real-world health care decisions and increasing research efficiency. However, PCTs also present ethical challenges. One such challenge involves the management of information that emerges in a PCT that is unrelated to the primary research question(s), yet may have implications for the individual patients, clinicians, or health care systems from whom or within which research data were collected. We term these findings as ?pragmatic clinical trial collateral findings,? or ?PCT-CFs?. In this article, we explore the ethical considerations associated with the identification, assessment, and management of PCT-CFs, and how these considerations may vary based upon the attributes of a specific PCT. Our purpose is to map the terrain of PCT-CFs to serve as a foundation for future scholarship as well as policy-making and to facilitate careful deliberation about actual cases as they occur in practice.
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Affiliation(s)
| | | | | | - Gail Geller
- Johns Hopkins University
- Johns Hopkins University School of Medicine
| | - Debra Jh Mathews
- Johns Hopkins University
- Johns Hopkins University School of Medicine
| | - Jeremy Sugarman
- Johns Hopkins University
- Johns Hopkins University School of Medicine
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20
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Brown SD, Bruno MA, Shyu JY, Eisenberg R, Abujudeh H, Norbash A, Gallagher TH. Error Disclosure and Apology in Radiology: The Case for Further Dialogue. Radiology 2019; 293:30-35. [DOI: 10.1148/radiol.2019190126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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21
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Dhawale T, Zech J, Greene SM, Roblin DW, Brigham KB, Gallagher TH, Mazor KM. We need to talk: Provider conversations with peers and patients about a medical error. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2019. [DOI: 10.1177/2516043519863578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Tejaswini Dhawale
- Center for Scholarship in Patient Care, Quality and Safety, University of Washington, Seattle, USA
| | - Jennifer Zech
- Mailman School of Public Health, ICAP at Columbia University, New York, USA
| | | | | | - Karen Berg Brigham
- Center for Scholarship in Patient Care, Quality and Safety, University of Washington, Seattle, USA
| | - Thomas H Gallagher
- Center for Scholarship in Patient Care, Quality and Safety, University of Washington, Seattle, USA
| | - Kathleen M Mazor
- Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, USA
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22
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Singh N. Characterizing Resident Preferences for Faculty Involvement and Support in Disclosing Medical Errors to Patients. J Grad Med Educ 2018; 10:394-399. [PMID: 30154968 PMCID: PMC6108362 DOI: 10.4300/jgme-d-17-00722.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/24/2018] [Accepted: 03/14/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Residents may be commonly involved with medical errors and need faculty support when disclosing these to patients. OBJECTIVE We characterized residents' preferences for faculty involvement and support during the error disclosure process. METHODS We surveyed residents from internal medicine, pediatrics, emergency medicine, general and orthopedic surgery, and obstetrics and gynecology residency programs at the University of Toronto in 2014-2015 about their preferences for faculty involvement across a variety of different error scenarios (ie, error type, severity, and proximity) and for elements of support they perceive to be most helpful during the disclosure process. RESULTS Over 90% of the 192 respondents (N = 538, response rate 36%) wanted direct involvement in the error disclosure process, irrespective of type or severity of the error. Residents were relatively comfortable disclosing prescription and communication errors without direct faculty involvement but preferred faculty involvement when disclosing diagnostic and management errors. When errors were severe, many residents still wanted to be involved but preferred having faculty lead the disclosure. Residents particularly wanted to participate in the process when they felt responsible for the error. Residents highly valued receiving faculty advice on how to manage consequences and how to prevent future errors in preparing for disclosure, as well as receiving postdisclosure feedback and personal support. CONCLUSIONS Residents are willing participants in the error disclosure process and have specific preferences for faculty involvement and support. These findings can inform faculty development to ensure appropriate support and supervision for residents when disclosing errors to patients.
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23
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Laposata M. The Definition and Scope of Diagnostic Error in the US and How Diagnostic Error is Enabled. J Appl Lab Med 2018; 3:128-134. [DOI: 10.1373/jalm.2017.025882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 03/07/2018] [Indexed: 11/06/2022]
Abstract
Abstract
Background
The quality of healthcare in the US has been progressively addressed by 3 reports from the National Academy of Medicine, the latest of which, entitled “Improving Diagnosis in Health Care,” was issued in 2015 from a 21-member panel (the author of this report was a member). The report is a review of the longstanding problem of diagnostic error. The infrastructure of healthcare delivery in the US has inadvertently made diagnostic error a major contributor to the high cost of care and preventable poor patient outcomes.
Content
This review describes the failures in US healthcare delivery that have led to the overwhelming number of deaths attributable to diagnostic error. Each failure is associated with recommendations to eliminate it. The review begins with a description of the scope of the diagnostic error problem and then discusses each of the issues that need to be addressed to reduce the number of misdiagnoses.
Summary
The problem of diagnostic error in the US is a large one. Some the contributing factors to this large problem can be resolved at a small expense and with modest change; others require a major overhaul of aspects of medical practice. For the first time, Americans have a “to-do list” to reduce our diagnostic error problem and be on par with other developed countries that are recognized as providing less costly care with better patient outcomes.
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Affiliation(s)
- Michael Laposata
- Department of Pathology, University of Texas Medical Branch, Galveston, TX
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24
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Specialist Physicians’ Attitudes and Practice Patterns Regarding Disclosure of Pre-referral Medical Errors. Ann Surg 2018; 267:1077-1083. [DOI: 10.1097/sla.0000000000002427] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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25
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Disclosure of Harmful Medical Error to Patients: A Review With Recommendations for Pathologists. Adv Anat Pathol 2018; 25:124-130. [PMID: 29356714 DOI: 10.1097/pap.0000000000000181] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Harmful error is an infrequent but serious challenge in the pathology laboratory. Regulatory bodies and advocacy groups have mandated and encouraged disclosure of error to patients. Many pathologists are interested in participating in disclosure of harmful error but are ill-equipped to do so. This review of the literature with recommendations examines the current state of the patient safety movement and error disclosure as it pertains to pathology and provides a practical and explicit guide for pathologists for who, when, and how to disclose harmful pathology error to patients. The authors provide a definition of harmful pathology error, and the rationale and principles behind effective disclosure are discussed. The changing culture of medicine and its effect on pathology is examined including the trend towards increasing transparency and patient engagement. Related topics are addressed including the management of expected adverse events, barriers to disclosure, and additional resources for the implementation of disclosure programs in pathology.
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26
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Transparency When Things Go Wrong: Physician Attitudes About Reporting Medical Errors to Patients, Peers, and Institutions. J Patient Saf 2017; 13:243-248. [DOI: 10.1097/pts.0000000000000153] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Tarrant C, Leslie M, Bion J, Dixon-Woods M. A qualitative study of speaking out about patient safety concerns in intensive care units. Soc Sci Med 2017; 193:8-15. [PMID: 28987982 PMCID: PMC5669358 DOI: 10.1016/j.socscimed.2017.09.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 09/19/2017] [Accepted: 09/20/2017] [Indexed: 11/23/2022]
Abstract
Much policy focus has been afforded to the role of "whistleblowers" in raising concerns about quality and safety of patient care in healthcare settings. However, most opportunities for personnel to identify and act on these concerns are likely to occur much further upstream, in the day-to-day mundane interactions of everyday work. Using qualitative data from over 900 h of ethnographic observation and 98 interviews across 19 English intensive care units (ICUs), we studied how personnel gave voice to concerns about patient safety or poor practice. We observed much low-level social control occurring as part of day-to-day functioning on the wards, with challenges and sanctions routinely used in an effort to prevent or address mistakes and norm violations. Pre-emptions were used to intervene when patients were at immediate risk, and included strategies such as gentle reminders, use of humour, and sharp words. Corrective interventions included education and evidence-based arguments, while sanctions that were applied when it appeared that a breach of safety had occurred included "quiet words", bantering, public exposure or humiliation, scoldings and brutal reprimands. These forms of social control generally functioned effectively to maintain safe practice. But they were not consistently effective, and sometimes risked reinforcing norms and idiosyncratic behaviours that were not necessarily aligned with goals of patient safety and high-quality healthcare. Further, making challenges across professional boundaries or hierarchies was sometimes problematic. Our findings suggest that an emphasis on formal reporting or communication training as the solution to giving voice to safety concerns is simplistic; a more sophisticated understanding of social control is needed.
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Affiliation(s)
- Carolyn Tarrant
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Myles Leslie
- Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Julian Bion
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Mary Dixon-Woods
- Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, UK.
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28
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Ethical Considerations on Disclosure When Medical Error Is Discovered During Medicolegal Death Investigation. Am J Forensic Med Pathol 2017; 38:294-297. [PMID: 28863125 DOI: 10.1097/paf.0000000000000343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the course of fulfilling their statutory role, physicians performing medicolegal investigations may recognize clinical colleagues' medical errors. If the error is found to have led directly to the patient's death (missed diagnosis or incorrect diagnosis, for example), then the forensic pathologist has a professional responsibility to include the information in the autopsy report and make sure that the family is appropriately informed. When the error is significant but did not lead directly to the patient's demise, ethical questions may arise regarding the obligations of the medical examiner to disclose the error to the clinicians or to the family. This case depicts the discovery of medical error likely unrelated to the cause of death and describes one possible ethical approach to disclosure derived from an ethical reasoning model addressing ethical principles of respect for persons/autonomy, beneficence, nonmaleficence, and justice.
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29
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Abstract
Errors are inherent in medicine due to the imperfectness of human nature. Health care providers may have a difficult time accepting their fallibility, acknowledging mistakes, and disclosing errors. Fear of litigation, shame, blame, and concern about reputation are just some of the barriers preventing physicians from being more candid with their patients, despite the supporting body of evidence that patients cite poor communication and lack of transparency as primary drivers to file a lawsuit in the wake of a medical complication. Proper error disclosure includes a timely explanation of what happened, who was involved, why the error occurred, and how it will be prevented in the future. Medical mistakes afford the opportunity for individuals and institutions to be candid about their weaknesses while improving patient care processes. When a physician takes the Hippocratic Oath they take on a tremendous sense of responsibility for the care of their patients, and often bear the burden of their mistakes in isolation. Physicians may struggle with guilt, shame, and a crisis of confidence, which may thwart efforts to identify areas for improvement that can lead to meaningful change. Coping strategies for providers include discussing the event with others, seeking professional counseling, and implementing quality improvement projects. Physicians and health care organizations need to find adaptive ways to deal with complications that will benefit patients, providers, and their institutions.
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Affiliation(s)
- Sevann Helo
- Division of Urology, Southern Illinois University, Springfield, IL, USA
| | - Carol-Anne E Moulton
- Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
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30
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Lipitz-Snyderman A, Kale M, Robbins L, Pfister D, Fortier E, Pocus V, Chimonas S, Weingart SN. Peers without fears? Barriers to effective communication among primary care physicians and oncologists about diagnostic delays in cancer. BMJ Qual Saf 2017; 26:892-898. [PMID: 28655713 DOI: 10.1136/bmjqs-2016-006181] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 04/13/2017] [Accepted: 04/24/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Relatively little attention has been devoted to the role of communication between physicians as a mechanism for individual and organisational learning about diagnostic delays. This study's objective was to elicit physicians' perceptions about and experiences with communication among physicians regarding diagnostic delays in cancer. DESIGN, SETTING, PARTICIPANTS Qualitative analysis based on seven focus groups. Fifty-one physicians affiliated with three New York-based academic medical centres participated, with six to nine subjects per group. We used content analysis to identify commonalities among primary care physicians and specialists (ie, medical and surgical oncologists). PRIMARY OUTCOME MEASURE Perceptions and experiences with physician-to-physician communication about delays in cancer diagnosis. RESULTS Our analysis identified five major themes: openness to communication, benefits of communication, fears about giving and receiving feedback, infrastructure barriers to communication and overcoming barriers to communication. Subjects valued communication about cancer diagnostic delays, but they had many concerns and fears about providing and receiving feedback in practice. Subjects expressed reluctance to communicate if there was insufficient information to attribute responsibility, if it would have no direct benefit or if it would jeopardise their existing relationships. They supported sensitive approaches to conveying information, as they feared eliciting or being subject to feelings of incompetence or shame. Subjects also cited organisational barriers. They offered suggestions that might facilitate communication about delays. CONCLUSIONS Addressing the barriers to communication among physicians about diagnostic delays is needed to promote a culture of learning across specialties and institutions. Supporting open and honest discussions about diagnostic delays may help build safer health systems.
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Affiliation(s)
- Allison Lipitz-Snyderman
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Minal Kale
- Icahn School of Medicine at Mount Sinai, Department of General Internal Medicine, New York, New York, USA
| | - Laura Robbins
- Hospital for Special Surgery, Research Division, New York, New York, USA
| | - David Pfister
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Elizabeth Fortier
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Valerie Pocus
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Susan Chimonas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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31
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Affiliation(s)
- John Y Kwon
- 1 Beth Israel Deaconess Medical Center, Harvard School of Medicine, Department of Orthopaedics, Boston, MA, USA
| | - Christopher P Miller
- 1 Beth Israel Deaconess Medical Center, Harvard School of Medicine, Department of Orthopaedics, Boston, MA, USA
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32
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Moffatt-Bruce SD. Public reporting: Will this help inform what patients and families need to know? J Thorac Cardiovasc Surg 2017; 153:1623-1626. [PMID: 28291604 DOI: 10.1016/j.jtcvs.2017.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 01/23/2017] [Accepted: 02/06/2017] [Indexed: 11/19/2022]
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33
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Vangipuram R, Horner ME, Menter A. Ethical dilemma in missed melanoma: What to tell the patient and other providers. J Am Acad Dermatol 2017; 76:365-367. [DOI: 10.1016/j.jaad.2016.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 08/11/2016] [Accepted: 08/12/2016] [Indexed: 11/28/2022]
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Shah VV, Kapp MB, Wolverton SE. Medical Malpractice in Dermatology-Part I: Reducing the Risks of a Lawsuit. Am J Clin Dermatol 2016; 17:593-600. [PMID: 27734331 DOI: 10.1007/s40257-016-0223-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Malpractice risk is a common source of concern for the practicing physician. Dermatologists experience fewer lawsuits than most other specialists in medicine, but the risk is not negligible. All physicians should familiarize themselves with areas of potential risk and avoid medico-legal pitfalls. We present Part I of a two-part series addressing medico-legal questions common to most practitioners that cause a great deal of anxiety. Part I will focus upon risk management and prevention of future malpractice lawsuits, and Part II deals with suggestions and guidance once a lawsuit occurs. Herein, we discuss the primary sources of malpractice lawsuits delivered against healthcare practitioners including issues with informed consent, patient noncompliance, medical negligence, and inappropriate documentation, including use of electronic medical records. The overall goal is to effectively avoid these common sources of litigation. The risk management strategies discussed in this paper are relevant to the everyday practitioner and may offer physicians some degree of protection from potential liability.
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Affiliation(s)
- Vidhi V Shah
- University of Missouri-Kansas City School of Medicine, 2411 Holmes St., Kansas City, MO, 64108, USA
| | - Marshall B Kapp
- Center for Innovative Collaboration in Medicine and Law, Florida State University College of Medicine and College of Law, 1115W. Call Street, Tallahassee, FL, 32306-4300, USA
| | - Stephen E Wolverton
- Department of Dermatology, Indiana University, 550N. University Blvd., Suite 3240, Indianapolis, IN, 46202, USA.
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35
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Patient Safety: Disclosure of Medical Errors and Risk Mitigation. Ann Thorac Surg 2016; 102:358-62. [DOI: 10.1016/j.athoracsur.2016.06.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 06/16/2016] [Indexed: 11/18/2022]
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36
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Giraldo P, Corbella J, Rodrigo C, Comas M, Sala M, Castells X. Análisis de las barreras y oportunidades legales-éticas de la comunicación y disculpa de errores asistenciales en España. GACETA SANITARIA 2016; 30:117-20. [DOI: 10.1016/j.gaceta.2015.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 11/16/2015] [Accepted: 11/19/2015] [Indexed: 10/22/2022]
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37
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Mazor K, Roblin DW, Greene SM, Fouayzi H, Gallagher TH. Primary care physicians’ willingness to disclose oncology errors involving multiple providers to patients. BMJ Qual Saf 2015; 25:787-95. [DOI: 10.1136/bmjqs-2015-004353] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 10/13/2015] [Indexed: 11/04/2022]
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38
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Connecting Patients and Clinicians: The Anticipated Effects of Open Notes on Patient Safety and Quality of Care. Jt Comm J Qual Patient Saf 2015. [PMID: 26215527 DOI: 10.1016/s1553-7250(15)41049-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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39
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Martinez W, Etchegaray JM, Thomas EJ, Hickson GB, Lehmann LS, Schleyer AM, Best JA, Shelburne JT, May NB, Bell SK. ‘Speaking up’ about patient safety concerns and unprofessional behaviour among residents: validation of two scales. BMJ Qual Saf 2015. [DOI: 10.1136/bmjqs-2015-004253] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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40
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Lipira LE, Gallagher TH. Disclosure of adverse events and errors in surgical care: challenges and strategies for improvement. World J Surg 2015; 38:1614-21. [PMID: 24763441 DOI: 10.1007/s00268-014-2564-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The disclosure of adverse events to patients, including those caused by medical errors, is a critical part of patient-centered healthcare and a fundamental component of patient safety and quality improvement. Disclosure benefits patients, providers, and healthcare institutions. However, the act of disclosure can be difficult for physicians. Surgeons struggle with disclosure in unique ways compared with other specialties, and disclosure in the surgical setting has specific challenges. The frequency of surgical adverse events along with a dysfunctional tort system, the team structure of surgical staff, and obstacles created inadvertently by existing surgical patient safety initiatives may contribute to an environment not conducive to disclosure. Fortunately, there are multiple strategies to address these barriers. Participation in communication and resolution programs, integration of Just Culture principles, surgical team disclosure planning, refinement of informed consent and morbidity and mortality processes, surgery-specific professional standards, and understanding the complexities of disclosing other clinicians' errors all have the potential to help surgeons provide patients with complete, satisfactory disclosures. Improvement in the regularity and quality of disclosures after surgical adverse events and errors will be key as the field of patient safety continues to advance.
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Affiliation(s)
- Lauren E Lipira
- Department of Medicine, University of Washington, Seattle, WA, USA,
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Lima-Oliveira G, Lippi G, Salvagno GL, Brocco G, Guidi GC. In vitro diagnostic company recalls and medical laboratory practices: an Italian case. Biochem Med (Zagreb) 2015; 25:273-8. [PMID: 26110040 PMCID: PMC4470101 DOI: 10.11613/bm.2015.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 04/30/2015] [Indexed: 11/29/2022] Open
Abstract
Introduction In vitro human diagnostic (IVD) company recalls are a common practice aimed to either minimize a potential error or eliminate an existing failure. In this case report, we aim to provide a critical analysis of a recent IVD recall and to provide a practical framework about what to do when an IVD company recalls product(s) based on the International Organization for Standardization - ISO 15189:2012 standard. Case report In 2014, Abbott Laboratories® (Green Oaks, IL) published an urgent field safety notice regarding a product recall (Architect Intact parathyroid hormone (PTH) Assay List Number 8K25) with immediate action required. The IVD company explained the reasons for the recall as follows: i) Abbott has confirmed that a performance shift in the Architect Intact PTH assay has the potential to generate falsely elevated results on patient samples; ii) results generated with impacted lots may demonstrate a positive shift relative to those generated with previous reagent and/or calibrator lots. This issue may also impact established Architect Intact PTH reference ranges; iii) the magnitude of shift averages approximately 13% to 45%; iv) Abbott Architect Intact PTH controls do not detect the shift; and v) all current reagent, calibrator, and control inventory are impacted. The recall could have resulted in ~40,000 inaccurate laboratory tests reported by 18 laboratories from Italy (Lombardy region). Conclusion IVD company recalls have a serious impact on the patient safety and require a thorough investigation and responsible approach to minimize the possible damage. Medical laboratories accredited according to the ISO 15189 standard have procedures in place to manage such situations and ensure that patient safety is maintained when such recalls are issued.
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Affiliation(s)
- Gabriel Lima-Oliveira
- Laboratory of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona, Italy
| | - Giuseppe Lippi
- Laboratory of Clinical Chemistry and Hematology, Academic Hospital of Parma, Parma, Italy
| | - Gian Luca Salvagno
- Laboratory of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona, Italy
| | - Giorgio Brocco
- Laboratory of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona, Italy
| | - Gian Cesare Guidi
- Laboratory of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona, Italy
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Wagner TH, Taylor T, Cowgill E, Asch SM, Su P, Bokhour B, Durfee J, Martinello RA, Maguire E, Elwy AR. Intended and unintended effects of large-scale adverse event disclosure: a controlled before-after analysis of five large-scale notifications. BMJ Qual Saf 2015; 24:295-302. [PMID: 25882785 PMCID: PMC4413746 DOI: 10.1136/bmjqs-2014-003800] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 03/06/2015] [Accepted: 03/15/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVE How patients respond to being notified of a large-scale adverse event (LSAE), such as improper sterilisation of medical equipment that exposes them to bloodborne pathogens, is not well known. The objective of this study was to determine, using administrative data, the intended and unintended consequences of patient notification following a LSAE. METHODS We examined five LSAEs where patients may have been inadvertently exposed to hepatitis C virus (HCV), HIV, and hepatitis B virus (HBV). A total of 9638 cases were identified at five Department of Veteran Affairs (VA) medical facilities between 2009 and 2012. We identified controls at the same facility prior to the exposure period and at neighbouring facilities (n=45,274). Difference-in-differences models were used with Veterans Health Administration (VHA) and Medicare data to examine infectious disease testing rates and subsequent utilisation patterns. RESULTS Receipt of a LSAE notification was associated with a 73.2, 76.8 and 77.1 adjusted percentage point increase for HCV, HIV and HBV testing, respectively (all p<0.001). Compared with white patients, African-American patients were significantly less likely to return to VHA for follow-up testing. Patients exposed to a dental LSAE reduced their use of preventive and restorative dental care over the subsequent year, but they eventually came back to VHA for dental services 18-months post exposure. CONCLUSIONS The majority of patients notified of a LSAE responded by getting tested for HCV, HIV and HBV, although there remains room for improvement. Potential exposure to a LSAE was associated with increased odds of subsequently using non-VA facilities, but the size and timing of the shift depended on the type of care.
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Affiliation(s)
- Todd H Wagner
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, USA
- Department of Health Research and Policy, Stanford University, Stanford, California, USA
| | - Thomas Taylor
- Department of Health Research and Policy, Stanford University, Stanford, California, USA
| | - Elizabeth Cowgill
- Department of Health Research and Policy, Stanford University, Stanford, California, USA
| | - Steven M Asch
- Department of Health Research and Policy, Stanford University, Stanford, California, USA
- Division of General Internal Medicine, Stanford University, Stanford California, USA
| | - Pon Su
- Department of Health Research and Policy, Stanford University, Stanford, California, USA
| | - Barbara Bokhour
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA
- Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Janet Durfee
- Veterans Health Administration, Office of Public Health, Washington DC, USA
| | - Richard A Martinello
- Veterans Health Administration, Office of Public Health, Washington DC, USA
- Yale School of Medicine, Departments of Internal Medicine and Pediatrics, New Haven, Conneticut, USA
| | - Elizabeth Maguire
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA
| | - A Rani Elwy
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA
- Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
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Cohen DA, Allen TC. Pathologists and medical error disclosure: don't wait for an invitation. Arch Pathol Lab Med 2015; 139:163-4. [PMID: 25611098 DOI: 10.5858/arpa.2014-0136-ed] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- David A Cohen
- From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Dr Cohen); and the Department of Pathology, University of Texas Medical Branch, Galveston (Dr Allen)
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Abstract
One of the most difficult experiences for any doctor or nurse is when they realize that they have made a mistake that has harmed a patient. In the past, mistakes were seldom disclosed to patients. The prevailing ethos was one of professional silence, secrecy, and shame. That has begun to change. Many professional organizations in both medicine and health law recommend full disclosure of mistakes and apologies for the harm that is caused. An atmosphere of openness and honesty leads to a culture of quality and safety. In this Ethics Rounds, we analyze the complex emotional and ethical issues that arise when doctors recognize that an error has occurred.
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Affiliation(s)
- Sigall K Bell
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Patient Safety and Quality Initiatives, Institute for Professionalism and Ethical Practice, and Department of Internal Medicine, and
| | - Keith J Mann
- University of Missouri at Kansas City, Kansas City, Missouri; and Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Robert Truog
- Division of Medical Ethics, Harvard Medical School, Boston, Massachusetts; Division of Critical Care Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - John D Lantos
- University of Missouri at Kansas City, Kansas City, Missouri; and Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, Missouri
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Lee BS, Gallagher TH. Saying "I'm sorry": error disclosure for ophthalmologists. Am J Ophthalmol 2014; 158:1108-1110.e2. [PMID: 25265916 DOI: 10.1016/j.ajo.2014.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 09/02/2014] [Accepted: 09/04/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Bryan S Lee
- Department of Ophthalmology, University of Washington, Seattle, Washington.
| | - Thomas H Gallagher
- Department of Medicine, University of Washington, Seattle, Washington; Department of Bioethics & Humanities, University of Washington, Seattle, Washington
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Padgett SM. ‘Looking like a bad person’: vocabulary of motives and narrative analysis in a story of nursing collegiality. Nurs Inq 2014; 22:221-30. [DOI: 10.1111/nin.12088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2014] [Indexed: 11/26/2022]
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Bruno MA, Petscavage-Thomas JM, Mohr MJ, Bell SK, Brown SD. The “Open Letter”: Radiologists' Reports in the Era of Patient Web Portals. J Am Coll Radiol 2014; 11:863-7. [DOI: 10.1016/j.jacr.2014.03.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 03/20/2014] [Indexed: 01/31/2023]
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Another Surgeon's Error: Must You Tell the Patient? Ann Thorac Surg 2014; 98:396-401. [DOI: 10.1016/j.athoracsur.2014.04.073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 03/07/2014] [Accepted: 04/08/2014] [Indexed: 11/23/2022]
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Schiff G, Griswold P, Ellis BR, Puopolo AL, Brede N, Nieva HR, Federico F, Leydon N, Ling J, Wachenheim D, Leape LL, Biondolillo M. Doing right by our patients when things go wrong in the ambulatory setting. Jt Comm J Qual Patient Saf 2014; 40:91-6. [PMID: 24716332 DOI: 10.1016/s1553-7250(14)40011-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Delivering the truth: challenges and opportunities for error disclosure in obstetrics. Obstet Gynecol 2014; 123:656-659. [PMID: 24499761 DOI: 10.1097/aog.0000000000000130] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Disclosing harmful medical errors to patients is a prominent component of the patient safety movement. Patients expect it and safety agencies and experts advocate its implementation. Obstetrics presents unique challenges to carrying out disclosure recommendations: childbirth is a life-changing, emotionally charged, and dynamic family event characterized by high expectations and unpredictability, and perinatal care is provided by complex ad hoc teams in a litigious area of medicine. Despite these challenges, transparent communication with parents about unexpected adverse birth outcomes remains critical. We call on clinicians and professional societies to pursue a deeper understanding of the unique challenges of disclosure in obstetrics and prepare themselves to conduct these difficult conversations well.
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