The "Seven Pillars" response to patient safety incidents: effects on medical liability processes and outcomes.
Approach to Improving Safety
Setting of Care
Research has demonstrated that disclosing errors to patients results in fewer malpractice claims, but such discussions do not always take place. This observational study described the effect of implementing the AHRQ Communication and Optimal Resolution (CANDOR) toolkit, an intervention bundle intended to support error disclosure, at a single health system. The investigators found that incident reports increased, suggesting that more safety problems were identified and reported. Also, the number of malpractice claims, along with their resultant costs, decreased significantly. Using an interrupted time series design, they established that these outcomes persisted more than 7 years after the program was introduced. The authors suggest that such programs can result in significant cost savings to health systems. A past PSNet perspective discussed error disclosure in health care.