Error Disclosure Research Articles

Implementing an error disclosure coaching model: A multicenter case study

National guidelines call for health care organizations to provide around-the-clock coaching for medical error disclosure. However, frontline clinicians may not always seek risk managers for coaching. As part of a demonstration project designed to improve patient safety and reduce malpractice liability, we trained multidisciplinary disclosure coaches at 8 health care organizations in Washington State. The training was highly rated by participants, although not all emerged confident in their coaching skill. This multisite intervention can serve as a model for other organizations looking to enhance existing disclosure capabilities. Success likely requires cultural change and repeated practice opportunities for coaches.

Patient safety awareness among postgraduate students and nurses in a tertiary health care facility.

Objective:To determine the knowledge of patient safety among postgraduate residents (PGR) and nurses in a tertiary care hospital.Methods:This casual comparative study was conducted among the postgraduate residents and nurses working at The Children’s Hospital Lahore in the month of July, August 2017. Both PGR and nurses were asked to complete APSQ-IV questionnaire about patient safety on 7 point Likert scale. Data was analyzed using SPSS version 20 and t-test was used to compare the mean score between two groups. The names of the participants were kept confidential.Results:A total of 150 residents and 150 nurses were included. The scores of both postgraduate residents and nurses were similar in all domains having positively worded questions with insignificant difference in mean score (p=0.141). In the reverse coded questions the nurses showed positive perception with higher mean score as compared to postgraduate residents (p=0.004). The postgraduate residents in the early years of residency had higher mean score in positively worded question as compared to residents who were in last years of training (p=0.006). There was no difference in the mean score of nurses as regard to their years of experience (p=0.733). Medical error disclosure domain was reported lowest by both postgraduate residents and nurses.Conclusion:Both postgraduate residents and nurses showed positive attitude with good knowledge and perception towards patient safety. Lowest rated scores were from error disclosure confidence domain.

Parent Preferences for Medical Error Disclosure: A Qualitative Study.

According to disclosure guidelines, patients experiencing adverse events due to medical errors should be offered full disclosure, whereas disclosure of near misses is not traditionally expected. This may conflict with parental expectations; surveys reveal most parents expect full disclosure whether errors resulted in harm or not. Protocols regarding whether to include children in these discussions have not been established. This study explores parent preferences around disclosure and views on including children. Fifteen parents of hospitalized children participated in semistructured interviews. Three hypothetical scenarios of different severity were used to initiate discussion. Interviews were audiotaped, transcribed, and coded for emergent themes. Parents uniformly wanted disclosure if harm occurred, although fewer wanted their child informed. For nonharmful errors, most parents wanted disclosure for themselves but few for their children.With respect to including children in disclosure, parents preferred to assess their children's cognitive and emotional readiness to cope with disclosure, wishing to act as a "buffer" between the health care team and their children. Generally, as event severity decreased, they felt that risks of informing children outweighed benefits. Parents strongly emphasized needing reassurance of a good final outcome and anticipated difficulty managing their emotions. Parents have mixed expectations regarding disclosure. Although survey studies indicate a stronger desire for disclosure of nonharmful events than for adult patients, this qualitative study revealed a greater degree of hesitation and complexity. Parents have a great need for reassurance and consistently wish to act as a buffer between the health care team and their children.

Medical errors in Nigeria: A cross-sectional study of medical practitioners in Abia State

Background: Human errors in health-care delivery have always been a challenge since the Hippocratic dictum “First, do no harm.” However, to achieve a complete error-free health care is a goal yet to be achieved by health professionals despite technological advances in patient care. Aim: The study was aimed at describing medical errors in a cross-section of medical practitioners in Abia State, Nigeria. Materials and Methods: A descriptive study was carried out on a cross-section of 145 medical practitioners in Abia State, Nigeria. Data collection was done using pretested, self-administered questionnaire that elicit information on types, committal, disclosure, and attitude to medical errors. Lawsuits and psychological disturbances associated with committal of medical errors were also studied. Results: The prevalence of medical errors was 42.8%. The three most common errors committed by the participants were an error of medication prescription (95.2%), error of radio-laboratory investigation ordering (83.9%), and error of physician diagnoses (69.4%). Sixty-two (100%) of the participants who committed medical errors had a negative attitude to error disclosure to the patients and their families. Of the 62 participants who committed medical errors, 33.8% were depressed. Among those that committed medical errors, none was involved in a lawsuit for medical errors. Committal of medical errors was associated with years of practice

Comparison of community and hospital pharmacists' attitudes and behaviors on medication error disclosure to the patient: A pilot study

ObjectivesTo determine pharmacists' attitudes and behaviors on medication errors and their disclosure and to compare community and hospital pharmacists on such views. MethodsAn online questionnaire was developed from previous studies on physicians' disclosure of errors. Questionnaire items included demographics, environment, personal experiences, and attitudes on medication errors and the disclosure process. An invitation to participate along with the link to the questionnaire was electronically distributed to members of two Illinois pharmacy associations. A follow-up reminder was sent 4 weeks after the original message. Data were collected for 3 months, and statistical analyses were performed with the use of IBM SPSS version 22.0. ResultsThe overall response rate was 23.3% (n = 422). The average employed respondent was a 51-year-old white woman with a BS Pharmacy degree working in a hospital pharmacy as a clinical staff member. Regardless of practice settings, pharmacist respondents agreed that medication errors were inevitable and that a disclosure process is necessary. Respondents from community and hospital settings were further analyzed to assess any differences. Community pharmacist respondents were more likely to agree that medication errors were inevitable and that pharmacists should address the patient's emotions when disclosing an error. Community pharmacist respondents were also more likely to agree that the health care professional most closely involved with the error should disclose the error to the patient and thought that it was the pharmacists' responsibility to disclose the error. Hospital pharmacist respondents were more likely to agree that it was important to include all details in a disclosure process and more likely to disagree on putting a “positive spin” on the event. ConclusionRegardless of practice setting, responding pharmacists generally agreed that errors should be disclosed to patients. There were, however, significant differences in their attitudes and behaviors depending on their particular practice setting.

Evaluation of Interprofessional Team Disclosure of a Medical Error to a Simulated Patient

Objective. To evaluate the impact of an Interprofessional Communication Skills Workshop on pharmacy student confidence and proficiency in disclosing medical errors to patients. Pharmacy student behavior was also compared to that of other health professions' students on the team. Design. Students from up to four different health professions participated in a simulation as part of an interprofessional team. Teams were evaluated with a validated rubric postsimulation on how well they handled the disclosure of an error to the patient. Individually, each student provided anonymous feedback and self-reflected on their abilities via a Likert-scale evaluation tool. A comparison of pharmacy students who completed the workshop (active group) vs all others who did not (control group) was completed and analyzed. Assessment. The majority of students felt they had adequate training related to communication issues that cause medication errors. However, fewer students believed that they knew how to report such an error to a patient or within a health system. Pharmacy students who completed the workshop were significantly more comfortable explicitly stating the error disclosure to a patient and/or caregiver and were more likely to apologize and respond to questions forthrightly (p<0.05). Conclusions. This data affirms the need to devote more time to training students on communicating with patients about the occurrence of medical errors and how to report these errors. Educators should be encouraged to incorporate such training within interprofessional education curricula.

Assessment of patient safety culture: what tools for medical students?

BackgroundThe assessment of patient safety culture refers mainly to surveys exploring the perceptions of health professionals in hospitals. These surveys have less relevance when considering the assessment of the patient safety culture of medical students, especially at university or medical school. They are indeed not fully integrated in care units and constitute a heterogeneous population. This work aimed to find appropriate assessment tools of the patient safety culture of medical students.MethodsSystematic review of the literature. Surveys related to a care unit were excluded. A typology of the patient safety culture of medical students was built from the included surveys.ResultsEighteen surveys were included. In our typology of patient safety culture of medical students (15 dimensions), the number of dimensions explored by survey (n) ranged from 1 to 12, with 6 “specialized” tools (n ≤ 4) and 12 “global” tools (N ≥ 5). These surveys have explored: knowledge about patient safety, acknowledgment of the inevitability of human error, the lack of skills as the main source of errors, the errors reporting systems, disclosure of medical errors to others health professionals or patients, teamwork and patient involvement to improve safety in care.ConclusionsWe recommend using Wetzel’s survey for making an overall assessment of the patient safety culture of medical students at university. In a specific purpose—e.g. to assess an educational program on medical error disclosure—the authors recommend to determine which dimensions of patient safety will be taught, to select the best assessment tool. Learning on patient safety should however be considered beyond the university. International translations of tools are required to create databases allowing comparative studies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0778-y) contains supplementary material, which is available to authorized users.

Disclosure of Medical Error.

Disclosure of Medical Error.

Error Disclosure in Pathology and Laboratory Medicine: A Review of the Literature

Since the 1990s, the fields of anatomic and clinical pathology have made strong commitments to improving patient safety, including the creation of formal and informal guidelines for assessing and reporting quality lapses. Unfortunately, some medical errors are inevitable. Patient safety experts advocate full and complete disclosure of all serious medical errors in an effort to preserve the patient-physician relationship and minimize the risk of harm to patients. While evidence suggests that most pathologists disclose serious medical errors, many do not disclose such errors to patients. A literature review of articles published on diagnostic error disclosure in pathology and laboratory medicine suggests that there are in fact persistent barriers to the disclosure of diagnostic errors that are specific to pathology. A number of these barriers are considered here, followed by recommendations for improving patient safety in pathology.

Disclosure of adverse outcomes in medicine: A questionnaire study on voice intention and behaviour of physicians in Germany, Japan and the USA

This study contributes to a better understanding of the determinants of voice expressed by physicians in different cultural settings. Voice, captured as disclosure of adverse outcomes and medical errors, is regarded as important for the reduction of the high rate of adverse events in medicine as compared to other high-risk professions. Within a cross-sectional, cross-cultural questionnaire study we explored the impact of selected individual, situational and organisational determinants for disclosure intention, and the behaviour of 251 physicians at three university hospitals in Germany, Japan and the USA. We found disclosure intention to be the lowest in Japan, while no cross-cultural differences existed for disclosure behaviour. Logistic regression analyses showed that culture moderated the effect of disclosure intention on behaviour. Only in Japan was disclosure behaviour a function of the level of disclosure intention. A written mistake disclosure policy encouraged voice behaviour, while internal attribution of medical errors and paternalism discouraged it.

Junior doctors and nurses' views and experiences of medical error: Moving toward shared learning and responsibility

Abstract Background Current guidelines for incident management and open disclosure emphasize team collaboration and openness yet little is known about how and to what extent junior doctors and nurses view and integrate these principles into their learning and practices. Purpose This research aimed to compare and contrast junior doctors and nurses' attitudes and experiences regarding medical error and open disclosure and how they would disclose errors. Method Junior doctors and nurses completed a survey containing closed item questions and free text responses to two hypothetical scenarios. Results The results indicated that the majority of respondents had personal involvement with near misses but experience with minor or serious errors were less common. Few had disclosed an error. Almost all agreed a serious error should be disclosed and 84% believed minor errors should be disclosed. Interns and nurses significantly differed in their views about the cause and importance of medical error and in their prior training experiences. Differences were also observed in the types of steps that respondents would take in managing an error. There was little recognition of the need to apologize when disclosing errors or to share the responsibility between the two professions. Conclusions Knowledge gaps and different orientations toward error management and open disclosure between the two professional groups were evident. Interprofessional education specifically targeting junior doctors and nurses and promoting the concept of team disclosure is needed. Such training should form an essential part of a health organization's response to medical error.

Modeling the hospital safety partnership preferences of patients and their families: a discrete choice conjoint experiment.

BackgroundPatients and their families play an important role in efforts to improve health service safety.ObjectiveThe objective of this study is to understand the safety partnership preferences of patients and their families.MethodWe used a discrete choice conjoint experiment to model the safety partnership preferences of 1,084 patients or those such as parents acting on their behalf. Participants made choices between hypothetical safety partnerships composed by experimentally varying 15 four-level partnership design attributes.ResultsParticipants preferred an approach to safety based on partnerships between patients and staff rather than a model delegating responsibility for safety to hospital staff. They valued the opportunity to participate in point of service safety partnerships, such as identity and medication double checks, that might afford an immediate risk reduction. Latent class analysis yielded two segments. Actively engaged participants (73.3%) comprised outpatients with higher education, who anticipated more benefits to safety partnerships, were more confident in their ability to contribute, and were more intent on participating. They were more likely to prefer a personal engagement strategy, valued scientific evidence, preferred a more active approach to safety education, and advocated disclosure of errors. The passively engaged segment (26.7%) anticipated fewer benefits, were less confident in their ability to contribute, and were less intent on participating. They were more likely to prefer an engagement strategy based on signage. They preferred that staff explain why they thought patients should help make care safer and decide whether errors were disclosed. Inpatients, those with immigrant backgrounds, and those with less education were more likely to be in this segment.ConclusionHealth services need to communicate information regarding risks, ask about partnership preferences, create opportunities respecting individual differences, and ensure a positive response when patients raise safety concerns.

Patient Safety: Disclosure of Medical Errors and Risk Mitigation

Patient Safety: Disclosure of Medical Errors and Risk Mitigation

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

BackgroundDespite growing interest in engaging patients and families (P/F) in patient safety education, little is known about how P/F can best contribute. We assessed the feasibility and acceptability of a...

The Past, Present, and Future of Simulation-based Education for Pediatric Emergency Medicine

The pediatric emergency medicine (PEM) environment is well suited for simulation-based activities, be they educational interventions for PEM learners, evaluations of the interface between health providers and the environment that they work in, or research investigations using simulation as a tool to answer specific clinical questions. As such, PEM has been among the leaders in the integration of this modality for clinical training. Traditionally, simulation has been used extensively for the dissemination of clinical training in the areas of clinical knowledge and its application, and the clinical, technical, and teamwork skills involved in PEM care. Increasingly, simulation is being used in novel applications, including breaking bad news, disclosure of error, family-centered care, quality and patient safety education, and system-level integration. The future will look to further identify, measure, and inform the integration of simulation with new and innovative adjuncts in the clinical environment, as well as to determine the optimal timing and use of simulation-based education to enhance the quality of care delivered to patients by the interprofessional and multidisciplinary team.

MEDICAL ERROR REPORTING

Introduction: A big challenge in the reduction of medical errors is lack of access to information of medical accidents. These types of events are considered as potential source for decrease and preventing harm to patients and increasing the standard of medical activities. Although, disclosing the adverse events and medical errors have been regarded as a significant issue for medical community, there has not been any clear guideline on how to report such errors. This study is aimed at analyzing effects of medical errors disclosed or reported. Materials and Methods: In this study, series of studies that had been done on the disclosure of medical errors was investigated. In this review, the articles published on the websites of Pubmed, science direct, ovid, google scholar, as well as the key terms of disclosure, medical error, reporting medical error were used. Conclusion: need for public education on the importance of “blaming” culture for lack of taking caring of patients' calls for useful flow of information. Error reduction process includes a long-term endeavor that requires continuous effort in an information cycle and disclosure patterns through error reduction information, analysis and assessment. All reviews need comprehensive cultural and legal backgrounds so that they pave way for presenting and revealing medical errors. Such procedures change disclosure of medical errors “catching someone red-handed” to culture of quality improvement and problem solving. The training workshop of unpredictable medical errors .

Learning by (video) example: a randomized study of communication skills training for end-of-life and error disclosure family care conferences

BackgroundTeaching residents to lead end of life (EOL) and error disclosure (ED) conferences is important. MethodsWe developed and tested an intervention using videotapes of EOL and error disclosure encounters from previous Objective Structured Clinical Exams. Residents (n = 72) from general and orthopedic surgery programs at 2 sites were enrolled. Using a prospective, pre-post, block group design with stratified randomization, we hypothesized the treatment group would outperform the control on EOL and ED cases. We also hypothesized that online course usage would correlate positively with post-test scores. ResultsAll residents improved (pre-post). At the group level, treatment effects were insignificant, and post-test performance was unrelated to course usage. At the subgroup level for EOL, low performers assigned to treatment scored higher than controls at post-test; and within the treatment group, post graduate year 3 residents outperformed post graduate year ​1 residents. ConclusionsTo be effective, online curricula illustrating communication behaviors need face-to-face interaction, individual role play with feedback and discussion.

Patient disclosure of medical errors in paediatrics: A systematic literature review.

Medical errors are common within paediatrics; however, little research has examined the process of disclosing medical errors in paediatric settings. The present systematic review of current research and policy initiatives examined evidence regarding the disclosure of medical errors involving paediatric patients. Peer-reviewed research from a range of scientific journals from the past 10 years is presented, and an overview of Canadian and international policies regarding disclosure in paediatric settings are provided. The purpose of the present review was to scope the existing literature and policy, and to synthesize findings into an integrated and accessible report. Future research priorities and policy implications are then identified.

Medical errors: Disclosure styles, interpersonal forgiveness, and outcomes

RationaleThis study investigates the intrapersonal and interpersonal factors and processes that are associated with patient forgiveness of a provider in the aftermath of a harmful medical error. ObjectiveThis study aims to examine what antecedents are most predictive of patient forgiveness and non-forgiveness, and the extent to which social-cognitive factors (i.e., fault attributions, empathy, rumination) influence the forgiveness process. Furthermore, the study evaluates the role of different disclosure styles in two different forgiveness models, and measures their respective causal outcomes. MethodsIn January 2011, 318 outpatients at Wake Forest Baptist Medical Center in the United States were randomly assigned to three hypothetical error disclosure vignettes that operationalized verbally effective disclosures with different nonverbal disclosure styles (i.e., high nonverbal involvement, low nonverbal involvement, written disclosure vignette without nonverbal information). All patients responded to the same forgiveness-related self-report measures after having been exposed to one of the vignettes. ResultsThe results favored the proximity model of interpersonal forgiveness, which implies that factors more proximal in time to the act of forgiving (i.e., patient rumination and empathy for the offender) are more predictive of forgiveness and non-forgiveness than less proximal factors (e.g., relationship variables and offense-related factors such as the presence or absence of an apology). Patients' fault attributions had no effect on their forgiveness across conditions. The results evidenced sizeable effects of physician nonverbal involvement-patients in the low nonverbal involvement condition perceived the error as more severe, experienced the physician's apology as less sincere, were more likely to blame the physician, felt less empathy, ruminated more about the error, were less likely to forgive and more likely to avoid the physician, reported less closeness, trust, and satisfaction but higher distress, were more likely to change doctors, less compliant, and more likely to seek legal advice. ConclusionThe findings of this study imply that physician nonverbal involvement during error disclosures stimulates a healing mechanism for patients and the physician-patient relationship. Physicians who disclose a medical error in a nonverbally uninvolved way, on the other hand, carry a higher malpractice risk and are less likely to promote healthy, reconciliatory outcomes.

Disclosure of medical errors involving gametes and embryos: an Ethics Committee opinion

Medical providers have an ethical duty to disclose clinically significant errors involving gametes and embryos as soon as they are discovered. Clinics also should have written policies in place for reducing and disclosing errors. This document was reviewed and affirmed in 2015 and replaces the earlier document of the same name (Fertil Steril 2011;96:1312-4).