Patients' knowledge and perceived reactions to medical errors in a tertiary health facility in Nigeria

Perception of the Disclosure of Adverse Events in a Latin American Culture: A National Survey

Introduction

Adverse events are common and are responsible for a significant burden in the healthcare setting. Such issues can vary according to the local culture and relevant policies. The current literature on the subject primarily addresses Anglo-Saxon cultures; this study focused on understanding the perception of disclosure in a middle-income country in Latin America.

Methods

In this descriptive study conducted from June-August, 2021, an online self-administered survey about disclosure practice used a convenience sample of 995 Brazilian healthcare professionals.

Results

Based on two different outcomes presented following a hypothetical adverse event (outcome 1: death; outcome 2: no permanent damage), 77.9% of participants fully agree that disclosure should be performed in both scenarios. Although 67.1% claimed that disclosure changes the perception of the institution by those involved, only 8.3% fully agree that there would be a reduction in trust regarding the institution. Despite only 11.5% of participants fully agreeing that disclosure increases the chance of legal action against professionals and institutions, 92.7% fully or partially agree that judicialization was possible in scenario 1, and 72.4% agree it was possible in scenario 2. Of the participants, 64.2% claimed they already faced a "disclosure" situation, and 44.3% fully believe that the person directly involved in the adverse event should participate in the disclosure.

Conclusion

In this sample of professionals from a middle-income country in Latin America, the practice of disclosure was considered ethical, and the majority of respondents affirmed that it should always be performed. Nonetheless, this call for transparency collides with participants' perception of a higher risk of legal action when disclosure is performed after a negative outcome situation.

How do patients respond to safety problems in ambulatory care? Results of a retrospective cross-sectional telephone survey

OBJECTIVES

Patients in German ambulatory care frequently report patient safety problems (PSP). It is unclear whether patients report PSP back to their general practitioner (GP) or specialist in charge. This study reports on how patients respond to experienced PSP.

DESIGN

Retrospective cross-sectional study.

SETTING

Computer-assisted telephone interviews (CATI) with randomly recruited citizens aged ≥40 years in Germany.

PARTICIPANTS

10 037 citizens ≥40 years. About 52% of the interviewees were female, 38% were between 60 and 79 years old and about 47% reported that they were chronically ill. A total of 2589 PSPs was reported.

PRIMARY AND SECONDARY MEASURES/RESULTS

According to the respondents (n=1422, 77%, 95% CI: 74.7 to 79.1), 72% (95% CI: 70.2 to 73.7) of PSP were reported back to the GP in charge or to another GP/specialist. Further reactions were taken by 65% (95% CI: 62.5 to 67.5) of the interviewees: around 63% (95% CI: 62.5 to 66.2) of the reported PSP led to a loss of faith in the physician or to complaints. χ2 and binary logistic regression analyses show significant associations between the (a) reporting and (b) reaction behaviour and determinants like 'medical treatment area' ((a) χ2=17.13, p=0.009/(b) χ2=97.58, p=0.000), 'PSP with/without harm' ((a) χ2=111.84, p=0.000/(b) χ2=265.39, p=0.000) and sociodemographic characteristics when respondents are aged between 40 and 59 years ((a) OR 2.57/(b) OR 2.60) or have chronic illnesses ((a) OR 2.16/(b) OR 2.14).

CONCLUSION

The data suggest that PSPs are frequently reported back to the GP or specialist in charge and have a significant serious impact on the physician-patient relationship. Much could be learnt from the patient reporting and reacting behaviour to prevent PSPs in ambulatory care.

Are patients knowledgeable of medical errors and medical complications? A cross-sectional study at a tertiary hospital, Riyadh

Background

Basic understanding of medical errors and medical complications is essential to ensure patient safety. Our aim in this study was to assess whether patients have sufficient knowledge of medical errors and medical complications and to identify the factors that influence their knowledge.

Methods

A cross-sectional study was conducted with 400 patients with a scheduled appointment at King Abdulaziz Medical City from 2019 to 2020. A self-administered validated questionnaire was developed by the coinvestigators. The first section focused on demographic information, and the second contained 17 scenarios to assess the knowledge of the patients. The data were analyzed with Chi-square test and logistic regression.

Results

The sample size realized as 346 (n = 346), with the majority (n = 198, 57%) female, and the mean age 39.5 ± 11 years. The mean scores for the medical errors and complications were 5.5 ± 2.10 and 4.8 ± 2.3, respectively. The participants with secondary education were less likely to have sufficient knowledge of both medical complications (OR 0.52, P = 0.016) and errors (OR 0.52, P = 0.016). In terms of age, the older participants, the 38-47 year age group, were less likely to be knowledgeable about medical complications compared to the younger age groups (OR 0.92, P = 0.046).

Conclusion

The patients had a higher level of knowledge about medical errors compared to medical complications. The level of education and the employment status significantly predicted the knowledge of both medical errors and complications.

Nghiên cứu nhận thức và thái độ của người bệnh và thân nhân đối với những rủi ro trong khám chữa bệnh hay sự cố y khoa tại Bệnh Viện Trường Đại Học Y Dược Huế năm 2019

Mở đầu: Nghiên cứu nhận thức và thái độ của người bệnh và thân nhân đối với những rủi ro trong khám chữa bệnh hay sự cố y khoa tại bệnh viện trường Đại học Y Dược Huế năm 2019. Phương pháp nghiên cứu: Nghiên cứu mô tả cắt ngang với bộ câu hỏi tên bệnh nhân nội trú và thân nhân người bệnh điều trị tại các khoa phòng, bệnh viện trường Đại học Y Dược Huế. Kết quả nghiên cứu cho thấy rằng có 72.3% người tham gia đã từng nghe (biết) về SCYK, chỉ có 36,3% nhóm đối tượng có kiến thức tốt về SCYK. 4,9% người tham gia trả lời rằng bản thân họ đã từng gặp phải những rủi ro trong khám chữa bệnh và 71,4% cho rằng các rủi ro này có tác động tiêu cực đến sức khỏe và cuộc sống của họ. 66,3% bệnh nhân và thân nhân người bệnh cho rằng SCYK hoàn toàn có thể phòng ngừa, có đến 76% đối tượng nghiên cứu muốn chủ động tìm hiểu về SCYK và 73,4% cho rằng CBYT nên tư vấn cho họ về những rủi ro có thể gặp phải trong quá trình khám chữa bệnh. 66,6% người tham gia cho rằng trình độ chuyên môn của cán bộ y tế là nguyên nhân chính gây SCYK. các nguyên nhân khác có thể dẫn đến SCYK, 64% đối tượng nghiên cứu cho rằng đó là ý thức bệnh nhân và những yếu tố liên quan đế cơ sở hạ tầng, trang thiết bị, … (60,9%). Kết luận: Tỉ lệ bệnh nhân và thân nhân người bệnh có kiến thức và thái độ tốt về các rủi ro trong khám chữa bệnh hay sự cố y khoa là chưa cao. Phải nhận thức rõ rằng, kiến thức và thái độ của bệnh nhân và thân nhân người bệnh là yếu tố quan trọng tác động đến việc hạn chế xảy ra sự cố y khoa cũng như đảm bảo an toàn tại cơ sở y tế và cải thiện chất lượng khám chữa bệnh.

Public preferences and attitudes towards the disclosure of medical errors: a survey in Iran

Awareness of the occurrence of medical errors is the right of patients and duty of the health service providers. This study was conducted to evaluate to what extent people want to know the occurrence of an error in their medical care, what they expect to be disclosed about medical error, and what are the influential factors in filing a lawsuit against physicians in disclosed medical errors from their point of view. In this cross-sectional survey, 1062 people residing in the city of Qom, Iran, were telephone interviewed using the random digit dialing method. The questionnaire used consisted of 4 demographic questions and 2 scenarios of major and minor medical error; the participants were asked if the physician should disclose the error in each scenario. The questionnaire also consisted of 16 questions about other issues related to error disclosure. Data were analyzed through descriptive and inferential statistics in SPSS software. About 99.1% of the study population believed that errors had to be disclosed to patients. They all wished to know that measures would be taken to prevent further errors. Moreover, 93.1% of the participants expected an explanation on the incident. As for the factors that decreased the likelihood of taking legal action against the physician from the viewpoint of the study population, treatment of the complications (96.1%) and honesty of the physician (95.8%) had the highest frequency. Based on the considerable preference of patients for error disclosure, it is recommended that physicians disclose all minor and major errors sympathetically and with transparency, honesty, and efforts to prevent future errors.

Frequency, Expected Effects, Obstacles, and Facilitators of Disclosure of Patient Safety Incidents: A Systematic Review

Objectives

We performed a systematic review to assess and aggregate the available evidence on the frequency, expected effects, obstacles, and facilitators of disclosure of patient safety incidents (DPSI).

Methods

We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for this systematic review and searched PubMed, Scopus, and the Cochrane Library for English articles published between 1990 and 2014. Two authors independently conducted the title screening and abstract review. Ninety-nine articles were selected for full-text reviews. One author extracted the data and another verified them.

Results

There was considerable variation in the reported frequency of DPSI among medical professionals. The main expected effects of DPSI were decreased intention of the general public to file medical lawsuits and punish medical professionals, increased credibility of medical professionals, increased intention of patients to revisit and recommend physicians or hospitals, higher ratings of quality of care, and alleviation of feelings of guilt among medical professionals. The obstacles to DPSI were fear of medical lawsuits and punishment, fear of a damaged professional reputation among colleagues and patients, diminished patient trust, the complexity of the situation, and the absence of a patient safety culture. However, the factors facilitating DPSI included the creation of a safe environment for reporting patient safety incidents, as well as guidelines and education for DPSI.

Conclusions

The reported frequency of the experience of the general public with DPSI was somewhat lower than the reported frequency of DPSI among medical professionals. Although we identified various expected effects of DPSI, more empirical evidence from real cases is required.

Obligation towards medical errors disclosure at a tertiary care hospital in Dubai, UAE

OBJECTIVE: The study aimed to identify healthcare providers’ obligation towards medical errors disclosure as well as to study the association between the severity of the medical error and the intention to disclose the error to the patients and their families.

DESIGN: A cross-sectional study design was followed to identify the magnitude of disclosure among healthcare providers in different departments at a randomly selected tertiary care hospital in Dubai.

SETTING AND PARTICIPANTS: The total sample size accounted for 106 respondents. Data were collected using a questionnaire composed of two sections namely; demographic variables of the respondents and a section which included variables relevant to medical error disclosure.

RESULTS: Statistical analysis yielded significant association between the obligation to disclose medical errors with male healthcare providers (X² = 5.1), and being a physician (X² = 19.3). Obligation towards medical errors disclosure was significantly associated with those healthcare providers who had not committed any medical errors during the past year (X² = 9.8), and any type of medical error regardless the cause, extent of harm (X² = 8.7). Variables included in the binary logistic regression model were; status (Exp β (Physician) = 0.39, 95% CI 0.16–0.97), gender (Exp β (Male) = 4.81, 95% CI 1.84–12.54), and medical errors during the last year (Exp β (None) = 2.11, 95% CI 0.6–2.3).

CONCLUSION: Education and training of physicians about disclosure conversations needs to start as early as medical school. Like the training in other competencies required of physicians, education in communicating about medical errors could help reduce physicians’ apprehension and make them more comfortable with disclosure conversations.

Learning without Borders: A Review of the Implementation of Medical Error Reporting in Médecins Sans Frontières

OBJECTIVE

To analyse the results from the first 3 years of implementation of a medical error reporting system in Médecins Sans Frontières-Operational Centre Amsterdam (MSF) programs.

METHODOLOGY

A medical error reporting policy was developed with input from frontline workers and introduced to the organisation in June 2010. The definition of medical error used was "the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim." All confirmed error reports were entered into a database without the use of personal identifiers.

RESULTS

179 errors were reported from 38 projects in 18 countries over the period of June 2010 to May 2013. The rate of reporting was 31, 42, and 106 incidents/year for reporting year 1, 2 and 3 respectively. The majority of errors were categorized as dispensing errors (62 cases or 34.6%), errors or delays in diagnosis (24 cases or 13.4%) and inappropriate treatment (19 cases or 10.6%). The impact of the error was categorized as no harm (58, 32.4%), harm (70, 39.1%), death (42, 23.5%) and unknown in 9 (5.0%) reports. Disclosure to the patient took place in 34 cases (19.0%), did not take place in 46 (25.7%), was not applicable for 5 (2.8%) cases and not reported for 94 (52.5%). Remedial actions introduced at headquarters level included guideline revisions and changes to medical supply procedures. At field level improvements included increased training and supervision, adjustments in staffing levels, and adaptations to the organization of the pharmacy.

CONCLUSION

It was feasible to implement a voluntary reporting system for medical errors despite the complex contexts in which MSF intervenes. The reporting policy led to system changes that improved patient safety and accountability to patients. Challenges remain in achieving widespread acceptance of the policy as evidenced by the low reporting and disclosure rates.