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Search results for "Hospitals"

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Journal Article > Study

Apologies following an adverse medical event: the importance of focusing on the consumer's needs.

Allan A, McKillop D, Dooley J, Allan MM, Preece DA. Patient Educ Couns. 2015;98:1058-1062.

In this study, participants observed two video-recorded scenarios of a surgeon apologizing for an adverse event. Although apologies that focused on admissions of responsibility, expressions of regret, and offers of restitution were viewed positively, those that also explicitly accounted for the patient's perspective by understanding the impact on the patient and offering to address the harm in a meaningful manner were better received.

Journal Article > Study

Pathologists' perspectives on disclosing harmful pathology error.

Dintzis SM, Clennon EK, Prouty CD, Reich LM, Elmore JG, Gallagher TH. Arch Pathol Lab Med. 2017;141:841-845.

Disclosure of medical errors is a recommended patient safety practice. This focus group study of pathologists found that most pathologists believe treating clinicians should disclose pathology errors and express concern that treating clinicians do not understand the inherent limitations of pathologic diagnosis. The authors suggest that developing consensus guidelines may improve disclosure of pathology errors.

Newspaper/Magazine Article

Two words can soothe patients who have been harmed: we're sorry.

Boodman SG. Kaiser Health News. March 15, 2017.

This news article reports on two incidents involving medical errors—one demonstrating the traditional shroud of secrecy and the other building on transparency and open disclosure—to illustrate the value of honest apology, discussion, and resolution of medical error for clinicians, patients, and families.

Journal Article > Review

Ethics in the pediatric emergency department: when mistakes happen: an approach to the process, evaluation, and response to medical errors.

Dreisinger N, Zapolsky N. Pediatr Emerg Care. 2017;33:128-131.

Emergency departments (ED) are complex environments that are prone to medical error. This review discusses elements of ED care that detract from patient safety and highlights the importance of reporting and discussing errors when they take place to develop prevention strategies. The authors also explore the evidence on transparency in the ED when an error occurs and how to make an appropriate apology.

Journal Article > Study

Learning through experience: influence of formal and informal training on medical error disclosure skills in residents.

Wong BM, Coffey M, Nousiainen MT, et al. J Grad Med Educ. 2017;9:66-72.

Error disclosure is universally recommended but incompletely implemented. Comparing disclosure skills among residents who completed experiential training to a historical cohort, this study found that current residents performed better. These results indicate that safety culture with respect to disclosure may be improving over time.

Journal Article > Review

Frequency, expected effects, obstacles, and facilitators of disclosure of patient safety incidents: a systematic review.

Ock M, Lim SY, Jo MW, Lee SI. J Prev Med Public Health. 2017;50:68-82.

This systematic review of disclosure of patient safety incidents found variation in the frequency of event disclosure. Motivation for disclosure included fostering trust with patients, reducing negative impact on health care professionals, and decreasing the risk of malpractice. Barriers to disclosure included fear of lawsuits and blame and a suboptimal patient safety culture. These results suggest that error disclosure remains incompletely implemented.

Journal Article

On Patient Safety.

Lee MJ. Clin Orthop Relat Res. 2013-2017.

This quarterly commentary explores a wide range of subjects associated with patient safety, such as the impact of disruptive behavior on teams, the value of apologies, and work hour reforms. Older materials are available online for free.

Journal Article > Commentary

Eliciting the functional processes of apologizing for errors in health care: developing an explanatory model of apology.

Prothero MM, Morse JM. Glob Qual Nurs Res. 2017 Mar 9; [Epub ahead of print].

Apology is an important component of a complete disclosure. This commentary explores the evolution of apology as a safety strategy in health care and how such conversations can help restore the patient–physician relationship after an error has occurred.

Journal Article > Study

Parent preferences for medical error disclosure: a qualitative study.

Coffey M, Espin S, Hahmann T, et al. Hosp Pediatr. 2017;7:24-30.

Research has established that disclosure of medical errors to patients and families is essential for maintaining a therapeutic alliance. However, less is known about what patients and families may expect regarding the disclosure of near misses. In this interview study, parents of hospitalized children expressed varying preferences surrounding disclosure of errors, near misses, and the degree to which they desired their children participate in the disclosure process.

Journal Article > Commentary

Inpatient Notes: mistakes in the hospital—communicating, apologizing, and beyond.

Kachalia A. Ann Intern Med. 2016;165:HO2-HO3.

Open discussion between clinicians can enable learning from errors and support a culture of safety. This commentary highlights how hospitalists can facilitate these discussions and help develop solutions to safety hazards that take into account their organization's unique context and culture.

Journal Article > Commentary

Disclosure of adverse events in pediatrics.

Committee on Medical Liability and Risk Management; Council on Quality Improvement and Patient Safety. Pediatrics. 2016;138(6).

Open disclosure of errors and adverse events is increasingly encouraged in health care. This policy statement discusses the ethical obligation for pediatricians to notify children and their parents about errors and offers recommendations to help improve disclosure in pediatric care.

Newspaper/Magazine Article

Balancing doctor egos and errors.

Sweeney JF. Med Econ. November 10, 2016.

Disclosure and candor with patients after a medical error has gained support from organizations, clinicians, and patients. This magazine article discusses how initiatives such as communication-and-resolution programs can reduce lawsuits, provide opportunities for learning, and improve physician–patient relationships.

Journal Article > Commentary

Tolerating uncertainty—the next medical revolution?

Simpkin AL, Schwartzstein RM. N Engl J Med. 2016;375:1713-1715.

Uncertainty is a difficult concept to accept for both patients and clinicians. This perspective explores how intolerance of uncertainty can affect safety in health care. The authors advocate for educators to encourage transparency about uncertainty and focus discussions on hypotheses instead of diagnoses.

Journal Article > Study

Case outcomes in a communication-and-resolution program in New York hospitals.

Mello MM, Greenberg Y, Senecal SK, Cohn JS. Health Serv Res. 2016;51(suppl 3):2583-2599.

Communication-and-resolution programs underscore the importance of early disclosure of medical error to patients and families. Prior research highlights implementation challenges associated with these efforts. Investigators analyzed 125 adverse event cases from 5 New York City hospitals over a 22-month period following the implementation of communication-and-resolution programs. The majority of cases did not involve substandard care, and disclosure occurred in more than 90% of cases.

Journal Article > Commentary

In support of the medical apology: the nonlegal arguments.

Heaton HA, Campbell RL, Thompson KM, Sadosty AT. J Emerg Med. 2016;51:605-609.

Appropriate apology is valuable to both the clinicians and patients involved. This commentary highlights why apologies are important to patients and providers and outlines a framework focused on "recognition, responsibility, regret, and remedy" to explore behaviors associated with effective apology.

Journal Article > Study

The "Seven Pillars" response to patient safety incidents: effects on medical liability processes and outcomes.

Lambert BL, Centomani NM, Smith KM, et al. Health Serv Res. 2016;51(suppl 3):2491-2515.

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.

Journal Article > Review

Error disclosure in pathology and laboratory medicine: a review of the literature.

Perkins IU. AMA J Ethics. 2016;18:809-816.

Disclosure of errors to patients and families contributes to transparency in health care. This review explores barriers to disclosing diagnostic errors to patients in pathology and laboratory medicine and makes recommendations to address these challenges.

Journal Article > Study

Surgeons' disclosures of clinical adverse events.

Elwy AR, Itani KMF, Bokhour BG, et al. JAMA Surg. 2016;151:1015-1021.

Even though disclosure of medical errors reduces litigation and patient distress, many providers remain uncomfortable with disclosing and apologizing for errors. In this survey of 67 surgeons across 3 medical centers, most reported prompt disclosure of adverse events. Surgeons who had difficult disclosure conversations experienced more anxiety. These results highlight the continued importance of supporting providers who experience emotional distress after medical errors.

Journal Article > Commentary

Patient safety: disclosure of medical errors and risk mitigation.

Moffatt-Bruce SD, Ferdinand FD, Fann JI. Ann Thorac Surg. 2016;102:358-362.

Although error disclosure is increasingly encouraged in health care, challenges to achieving transparency include liability and risk considerations, particularly for surgeons. This commentary describes the experiences of two health care systems that have implemented approaches to support transparent disclosure of medical errors.

Journal Article > Study

Patients and families as teachers: a mixed methods assessment of a collaborative learning model for medical error disclosure and prevention.

Langer T, Martinez W, Browning DM, Varrin P, Sarnoff Lee B, Bell SK. BMJ Qual Saf. 2016;25:615-625.

Health systems struggle with how to effectively involve patients in safety efforts without placing undue responsibility or blame on them. Greater patient–clinician collaboration is particularly important for error disclosure because of the well-documented gaps in clinician and patient perspectives. In this study, investigators developed an intervention to have patients or family members teach error disclosure and prevention to interprofessional clinician learners, including physicians, nurses, and social workers. Their pre–post evaluation showed that the majority of patient and clinician participants reported improved communication and found the intervention valuable. Patient and clinician participation was voluntary. Although these results show promise for involving patients and families as teachers for error disclosure and prevention training, further work is needed to determine whether this approach will be effective among broader health care teams, as opposed to interested clinicians who volunteer. A related editorial discusses the challenges of including patients in safety efforts.

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