Error Disclosure Research Articles

Disclosure of medical errors to patients by medical professionals: a protocol for a qualitative systematic review

IntroductionAlthough the disclosure of medical errors is an integral component of medical ethics, it remains inconsistent in practice worldwide. Despite various explanations of why healthcare professionals reveal their mistakes to...

The medicolegal challenges in spine care of professional athletes

Professional athletes are prone to spinal injuries, and the treatment of this distinct patient population involves additional medicolegal challenges that must be considered. Catastrophic complications and delay in treatment of complications are linked with plaintiff verdicts in legal claims. Clear communication, thorough informed consent, and prompt disclosure of errors or complications can mitigate litigation risks. Effective collaboration with the athletic team is important in optimizing a safe return to competitive play.

Organizational and Individual Contributing Factors to Safety Climate in Healthcare Industries - Bayesian Network Predictive Modeling Approach.

The current study aims to identify individual and joint drivers that significantly influence the safety climate in healthcare industries by using Bayesian Network simulations for an in-depth analysis. Survey data were collected from 452 employees from two branches of one hospital in China for a study about workplace safety. The original English surveys were translated into Chinese using the back-translation procedure recommended by Brislin. Employees were asked to complete two online surveys with one month in between each administration. The sample was 42% doctors and 58% nurses. A Bayesian Network (BN) model, based on theory, was updated and complemented with expert knowledge. A graphical model based on expert knowledge and data-driven machine learning approaches was used to refine the BN structure, representing interrelationships among all studied variables. The BN model was employed to identify the best key drivers and joint strategies for safety climate improvement. The Bayesian Network model demonstrated a good overall fit. The Euclidean distance metric was used to assess the influence between connected variables, with interpersonal trust and locus of control having the strongest independent effects on safety climate among the five contributing factors. Joint strategies, particularly joint optimization of error disclosure culture and interpersonal trust, as well as error disclosure culture and self-efficacy, were most effective in promoting a safe climate. The findings suggest that hospital safety climate can be improved by providing a psychologically safe error disclosure culture and enhancing interpersonal trust among employees and their self-efficacy.

Crowdsourced Feedback to Improve Resident Physician Error Disclosure Skills

Residents must prepare for effective communication with patients after medical errors. The video-based communication assessment (VCA) is software that plays video of a patient scenario, asks the physician to record what they would say, engages crowdsourced laypeople to rate audio recordings of physician responses, and presents feedback to physicians. To evaluate the effectiveness of VCA feedback in resident error disclosure skill training. This single-blinded, randomized clinical trial was conducted from July 2022 to May 2023 at 7 US internal medicine and family medicine residencies (10 total sites). Participants were second-year residents attending required teaching conferences. Data analysis was performed from July to December 2023. Residents completed 2 VCA cases at time 1 and were randomized to the intervention, an individual feedback report provided in the VCA application after 2 weeks, or to control, in which feedback was not provided until after time 2. Residents completed 2 additional VCA cases after 4 weeks (time 2). Panels of crowdsourced laypeople rated recordings of residents disclosing simulated medical errors to create scores on a 5-point scale. Reports included learning points derived from layperson comments. Mean time 2 ratings were compared to test the hypothesis that residents who had access to feedback on their time 1 performance would score higher at time 2 than those without feedback access. Residents were surveyed about demographic characteristics, disclosure experience, and feedback use. The intervention's effect was examined using analysis of covariance. A total of 146 residents (87 [60.0%] aged 25-29 years; 60 female [41.0%]) completed the time 1 VCA, and 103 (70.5%) completed the time 2 VCA (53 randomized to intervention and 50 randomized to control); of those, 28 (54.9%) reported reviewing their feedback. Analysis of covariance found a significant main effect of feedback between intervention and control groups at time 2 (mean [SD] score, 3.26 [0.45] vs 3.14 [0.39]; difference, 0.12; 95% CI, 0.08-0.48; P = .01). In post hoc comparisons restricted to residents without prior disclosure experience, intervention residents scored higher than those in the control group at time 2 (mean [SD] score, 3.33 [0.43] vs 3.09 [0.44]; difference, 0.24; 95% CI, 0.01-0.48; P = .007). Worse performance at time 1 was associated with increased likelihood of dropping out before time 2 (odds ratio, 2.89; 95% CI, 1.06-7.84; P = .04). In this randomized clinical trial, self-directed review of crowdsourced feedback was associated with higher ratings of internal medicine and family medicine residents' error disclosure skill, particularly for those without real-life error disclosure experience, suggesting that such feedback may be an effective way for residency programs to address their requirement to prepare trainees for communicating with patients after medical harm. ClinicalTrials.gov Identifier: NCT06234085.

Assessment of the understanding and awareness of bioethics among healthcare professionals in all public and private hospitals of Haripur district, Pakistan: a multicentre cross-sectional study

ObjectiveTo assess the level of bioethics awareness among healthcare professionals in Pakistan, focusing on the associations with sociodemographic characteristics, training and teaching of ethics, medical ethics practice and specific ethical...

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

Medical providers have an ethical duty to disclose clinically significant errors involving gametes and embryos. Although not mandatory, disclosure of errors causing no harm or near misses is recommended. In addition, clinics should have written policies in place for reducing and disclosing errors.

The Perception and Preference of Patients towards Disclosure of Medical Errors: A Report from Guilan Academic Hospitals

Background: It is well known that disclosure of Medical Errors (MEs) is the duty of physicians and it is the right of patients to be aware of any error occurring in their medical care process. This study was planned to asses to what extent the patients expect to be informed of the occurrence of MEs, they prefer who reports the medical error to them, and what are the influential factors in taking legal action against physicians in disclosed MEs from their point of view. Methods: In this cross-sectional study, eligible patients admitted to academic hospitals of Guilan (Poorsina; Razi; Alzahra; Amir Al-Momenin; Dr. Heshmat), were interviewed directly and a questionnaire which was divided into four sections was filled out. The first part was about socio-demographic data of the responders and the next three sections included their preferences towards the type of MEs to be disclosed, who is responsible for this task, and in which conditions they sue against the medical team. Results: About 96.6% of the patients believed that MEs had to be disclosed to the patients. Moreover, 29.3% preferred to be informed about all MEs that occurred during their medical care even if it caused no harm. 51.1% expected that physician who committed the error informs the error. On the whole age, gender, employment status, residency and education were among the influential factors of the patients’ willingness and point of view and filing a lawsuit against physicians. Conclusion: Based on the findings of this study, it is recommended that all minor and major MEs should be disclosed sympathetically by the physician who committed the error.

Analisis Kerentanan Pada Domain Repository Unjaya Menggunakan Kerangka Information System Security Assessment Framework (ISAFF)

Vulnerability analysis on the Unjaya Repository website uses the ISSAF method for identifying and grouping identified vulnerabilities.. The purpose is to provide an in-depth understanding of the vulnerabilities that exist on the Repository site as a basis for the corrective steps needed to reduce security risks. The methods are information gathering, network mapping, vulnerability exposure, vulnerability grouping, IP addresses, active ports. Scanning using Nikto Scanner and Helium Security, 24 vulnerabilities detected in four levels, namely high, medium, low and informational. The results found at a high level of vulnerability in the form of disclosure of PII, at a medium level such as the absence of an Anti-CSRF Token, at a low level such as Application Error Disclosure, and at an information level such as Authentication Request Identified. This proves that there is a significant potential risk to the security of the Unjaya Repository site.

Lebanese medical students' attitudes towards patient safety and medical error disclosure: A cross-sectional study.

To assess Lebanese medical students' attitudes towards patient safety and medical error disclosure. This was a cross-sectional study involving medical students from seven different medical schools in Lebanon. The participants completed the Attitudes to Patient Safety Questionnaire (APSQ-III) online, which consists of 26 items across nine key patient safety domains. Items were scored from 1 (strongly disagree) to 5 (strongly agree). Demographic data were also collected. Of the 549 students enrolled in the study, 325 (59%) were female and 224 (41%) were male. More than half (287, 52%) were aged between 20 and 22 years and 95% were Lebanese. The overall attitude of students towards patient safety was positive (3.59 ± 0.85) with the most positive attitudes in the domains of 'Team functioning' followed by 'Working hours as an error cause'. More positive attitudes were perceived among male students in the domains of 'Professional incompetence as an error cause' and 'Disclosure responsibility' whereas more positive attitudes were seen in female students in the domain of 'Working hour as an error cause'. Older medical students had more positive attitudes in the domain of 'Team functioning' than younger students. Medical students in Lebanon had an overall positive attitude towards patient safety. These findings may be used to guide improvements in patient safety education and enhance patient-centred care in medical institutions in Lebanon.

How to HEEAL: A Patient and Peer-Centric Simulation Curriculum for Medical Error Disclosure.

Medical errors are an unfortunate certainty with emotional and psychological consequences for patients and health care providers. No standardized medical curriculum on how to disclose medical errors to patients or peers exists. The novel HEEAL (honesty/empathy/education/apology-awareness/lessen chance for future errors) curriculum addresses this gap in medical education through a multimodality workshop. This 6-hour, two-part curriculum incorporated didactic and standardized patient (SP) simulation education with rapid cycle deliberate practice (RCDP). The morning focused on provider-patient error disclosure; the afternoon applied the same principles to provider-provider (peer) discussion. Summative simulations with SPs evaluated learners' skill baseline and improvement. Formative simulations run by expert simulation educators used RCDP to provide real-time feedback and opportunities for adjustment. Medical knowledge was measured through pre- and postintervention multiple-choice questions. Learners' confidence and attitude towards medical errors disclosure were surveyed pre- and postintervention with assistance of the Barriers to Error Disclosure Assessment tool, revised with the addition of several questions related to provider-provider disclosure. Fourteen medical students participated in this pilot curriculum. Statistical significance was demonstrated in medical knowledge (p = .01), peer-disclosure skills (p = .001), and confidence in medical error disclosure (p < .001). Although there was improvement in patient-disclosure skills, this did not reach statistical significance (p = .05). This curriculum addresses the need for designated training in medical error disclosure. Learners gained knowledge, skills, and confidence in medical error disclosure. We recommend this curriculum for medical students preparing for transition to residency.

Censored: Examining the Standards, Personnel, and Censorship Technology in the Soviet Military Press, 1944–1945

This article examines one of the areas of activity for restriction of information – the system of military censorship in the Soviet military press: what remained unchanged and what was transformed in its work on protecting information, which was a military secret between 1944 and 1945. The study focuses on the regulatory framework of military censorship, the objects of the ban, the censor's personnel, technology of censorship control. Until December 1943 in the Red Army, there was a ‘Regulation on the organization of military censorship’ of 1935, which did not meet wartime requirements. The new ‘Regulation’ corrected the situation. The change and addition of the composition of the information constituting military secrets were directly affected by the course of combat operations during the Red Army’s campaign in Europe. The subject of censorship prevented the disclosure of military secrets, political errors, and information undesirable to publish in the military press.

Disclosure following a medical error: lessons learned from a national initiative of workshops with patients, healthcare teams, and executives

BackgroundDespite the increase in disclosures of medical errors, transparency remains a challenge. Recognized barriers include shame, fear of litigation, disciplinary actions, and loss of patient trust. In 2018, the Israeli Ministry of Health initiated a series of workshops about disclosure of medical errors. The workshops involved medical center executives, healthcare providers, patients, and family members of patients who had previously been harmed by a medical error. This study presents the lessons learned about perceived challenges in disclosure of errors in 15 such workshops.MethodsData collection included participant observations in 15 workshops, full audio recordings of all of the workshops, and documentation of detailed field notes. Analysis was performed under thematic analysis guidelines.ResultsWe identified four main themes: “Providers agree on the value of disclosure of a medical error to the patient”; “Emotional challenges of disclosure of medical error to patients”; “The medico-legal discourse challenges transparency”; and “Providers and patients call for a change in the culture regarding disclosure of medical errors”. Participant observations indicated that the presence of a patient who had experienced a tragedy in another hospital, and who was willing to share it created an intimate atmosphere that enabled an open conversation between parties.ConclusionThe study shows the moral, human, and educational values of open discourse in a protective setting after the occurrence of a medical error. We believe that workshops like these may help foster a culture of institutional disclosure following medical errors. We recommend that the Ministry of Health extend such workshops to all healthcare facilities, establish guidelines and mandate training for skills in disclosure for all providers.

Medical Error Disclosure: An Entrustable Professional Activity During an Objective Standardized Clinical Examination for Clerkship Students.

Most health care providers will be involved in a medical error during their careers. It is critical that future physicians receive formal training on error disclosure. We designed a formative skills-based objective standardized clinical exam (OSCE) for fourth-year medical students to assess competence in disclosing an error during a required entrustable professional activity. Faculty observed the encounter and completed a checklist evaluating students' performance in communication skills and content knowledge. Students received immediate formative feedback. They then participated in a facilitated case-based experience, discussed the critical elements of disclosure, utilized role-play to reinforce skills, and reflected on self-care practices. Finally, students completed a survey evaluating their perception of the OSCE's impact on their disclosure knowledge, skills, and attitudes. Ninety-two students participated in the OSCE. Of those, 67 (73%) completed a retrospective pre/post survey assessing their disclosure knowledge, skills, and attitudes. Forty-one (62%) did not identify the error. Students who identified the error (26, 39%) were more likely to use the two-patient identifier than students who did not identify the error, χ2(1) = 13.3, p < .001. Self-reported comfort and confidence in disclosure improved, as did self-care practices (ps ≤ .005). Students agreed that health care providers should disclose an error and know how to do so. Student self-reported comfort in disclosure and knowledge of how to disclose and how to report an error all improved following the OSCE and structured debrief. The OSCE and case-based experience can be adapted for implementation in curricula about error disclosure.

Psychometric Properties of Chinese Version of the Barriers to Error Disclosure Assessment (C-BEDA) Tool.

The Barriers to Error Disclosure Assessment (BEDA) tool is used to measure barriers to the disclosure of medical errors by healthcare professionals. This study aimed to evaluate the psychometric properties of the Chinese version of the BEDA (C-BEDA). The culture of disclosure and transparency in response to medical errors has been recommended in recent years. However, there are no relevant assessment tools for measuring barriers to disclosing medical errors in China. The C-BEDA tool underwent translation, back translation, cross-cultural adaptation in a pilot study. It was tested with 1254healthcare professionals in Guizhou and Sichuan Provinces, China. The content validity index (CVI) was used to evaluate the content validity of the C-BEDA, and exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to evaluate its structural validity. The Cronbach's α coefficient and test-retest reliability were evaluated to determine its reliability. Three factors were extracted by EFA that explained 65.892% of the total variance of the C-BEDA tool. CFA showed a good fit for a three-factor structure with acceptable values: goodness-of-fit index=0.939; adjusted goodness-of-fit index=0.911; incremental fit index=0.967; comparative fit index=0.967; partial least squares path modeling for confirmatory factor analysis=0.735; and root mean square error of approximation=0.058. The item-level content validity index ranged from 0.86 to 1.00, and the average scale-level content validity index was 0.98. The Cronbach's α coefficient (0.909) and test-retest reliability (0.86) were acceptable. The C-BEDA toolis a valid and reliable tool for assessing the extent of barriers to error disclosure among Chinese healthcare professionals.

Experiences and Perceptions of Healthcare Stakeholders in Disclosing Errors and Adverse Events to Historically Marginalized Patients.

We sought to assess the experiences and perceptions of healthcare stakeholders involved in the response to historically marginalized patients who have been harmed in healthcare. We investigated the challenges in disclosing errors and adverse events and the types of tools and resources that would better address the needs of historically marginalized patient populations. We conducted separate focus groups with two healthcare stakeholder groups: (1) frontline clinicians directly involved in the clinical care of historically marginalized patients and (2) risk and patient safety professionals involved in the hospital response to care breakdowns. We conducted an inductive analysis of the qualitative data to identify thematic clusters. We interviewed 7 clinicians and 5 risk safety professionals, with a total sample size of 12 participants. Participants shared multilevel challenges in responding to historically marginalized patients after harm (system-, organizational-, and patient-level), such as fragmentation of care, lack of standardized protocols, and patient mistrust. Participants also identified their desired tools and resources for disclosure to meet the needs of historically marginalized patients, which included culturally appropriate toolkits, disclosure training, and the inclusion of multidisciplinary healthcare team members in the disclosure process. Our results suggest that multiple interventions will be needed to achieve the goal of prompt disclosure of errors and adverse events across all populations engaged in health care. Future studies should investigate the perspectives of historically marginalized patients and their family members on how error and adverse event disclosure conversations should unfold.

HEEALing after an error – use of the novel mnemonic HEEAL to structure error disclosure to patients and peers

First, to determine the feasibility of providing a simple educational intervention using the HEEAL (Honesty, Empathy, Educate, Apology/awareness, Lessen the chance for future errors) mnemonic. Second, to assess the intervention’s ability to improve communication self-efficacy, knowledge and objective measures of error disclosure competence among providers. A 1-day (6-hour) pilot medical error curriculum was created to teach the HEEAL method of medical error disclosure to both patients and peers who have committed errors. The four-part curriculum consists of pre-intervention evaluation, HEEAL content lecture, rapid cycle deliberate practice (RCDP) with debriefing and post-intervention evaluation. This curriculum was repeated twice. The first training focused on medical error disclosure to patients’ families and the second on medical error disclosure to involved peers. Participating faculty developed, adapted and piloted simulation cases, skills checklists and knowledge questionnaires. The barriers to error disclosure assessment (BEDA) tool served as our confidence survey. Five additional questions developed and piloted by the research team were administered with the BEDA to assess learner confidence with peer–peer disclosure. Pre- and post-intervention written measures of knowledge and confidence (BEDA) were obtained for both iterations of the curriculum. Assessment of observed clinical skills was scored by the involved SP (standardized patient) immediately following the RCDP. An Fourteen learners completed all curricular components. Learners demonstrated statistically significant improvement in their confidence in medical error disclosure ( This pilot data suggest that the HEEAL intervention provides an effective and efficient way for medical educators to teach senior medical students how to provide competent error disclosure to both patients and peers.

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Purpose: This study aimed to examine the students’ errors in composition writing. Theoretical Framework: This study is anchored to Corder’s (1974) model of error analysis in order to identify errors of the learners in their composition writing. The errors were discussed in five stages: collection of data containing errors, classification of errors, identification of errors, disclosure and evaluation of errors. Design/Methodology/Approach: The descriptive approach was used using qualitative and quantitative data since the study analyzed the errors committed by the students in composition writing. Moreover, descriptive design was used since the profile of the respondents in terms of sex was described. Lastly, error analysis was used in identifying the errors committed by the students in the writing of their autobiography. Findings: The study found that the Second Language Learners have committed numerous errors under mechanical, grammatical and structural categories such as: misspelling, lack of punctuation marks, errors in capitalization, wrong tense of verb, wrong subject and verb agreement, missing prepositions, fragments, faulty parallelism and comma splice. Research, Practical &amp; Social Implications: This study has implications to language teaching and learning. Language professors should always incorporate lessons in grammar in all language courses. Further, the language learners should be more exposed to multiple writing tasks to enhance their writing skills. Originality/ Value: Development of an evidence-based English remedial program to improve the English proficiency and academic writing skills of second language learners in higher institutions.

Analysis of Second Language Learners’ Errors in Composition Writing: Basis for the Proposed English Remedial Program in Higher Institution

Purpose: This study aimed to examine the students’ errors in composition writing.&#x0D; &#x0D; Theoretical Framework: This study is anchored to Corder’s (1974) model of error analysis in order to identify errors of the learners in their composition writing. The errors were discussed in five stages: collection of data containing errors, classification of errors, identification of errors, disclosure and evaluation of errors.&#x0D; &#x0D; Design/Methodology/Approach: The descriptive approach was used using qualitative and quantitative data since the study analyzed the errors committed by the students in composition writing. Moreover, descriptive design was used since the profile of the respondents in terms of sex was described. Lastly, error analysis was used in identifying the errors committed by the students in the writing of their autobiography.&#x0D; &#x0D; Findings: The study found that the Second Language Learners have committed numerous errors under mechanical, grammatical and structural categories such as: misspelling, lack of punctuation marks, errors in capitalization, wrong tense of verb, wrong subject and verb agreement, missing prepositions, fragments, faulty parallelism and comma splice.&#x0D; &#x0D; Research, Practical &amp; Social Implications: This study has implications to language teaching and learning. Language professors should always incorporate lessons in grammar in all language courses. Further, the language learners should be more exposed to multiple writing tasks to enhance their writing skills. &#x0D; &#x0D; Originality/ Value: Development of an evidence-based English remedial program to improve the English proficiency and academic writing skills of second language learners in higher institutions.

Adapting Compassionate Conversations for Virtual Mediated Communication

The Covid-19 pandemic resulted in a shift in communication of difficult, emotionally charged topics from almost entirely in-person to virtual mediated communication (VMC) methods due to restrictions on visitation for safety. The objective was to train residents in VMC and assess performance across multiple specialties and institutions. The authors designed a teaching program including asynchronous preparation with videos, case simulation experiences with standardized patients (SPs), and coaching from a trained faculty member. Three topics were included - breaking bad news (BBN), goals of care / health care decision making (GOC), and disclosure of medical error (DOME). A performance evaluation was created and used by the coaches and standardized patients to assess the learners. Trends in performance between simulations and sessions were assessed. Four academic university hospitals - Virginia Commonwealth University Medical Center in Richmond, Virginia, The Ohio State University Wexner Medical Center in Columbus, Ohio, Baylor University Medical Center in Dallas, Texas and The University of Cincinnati in Cincinnati, Ohio- participated. Learners totaled 34 including 21 emergency medicine interns, 9 general surgery interns and 4 medical students entering surgical training. Learner participation was voluntary. Recruitment was done via emails sent by program directors and study coordinators. A statistically significant improvement in mean performance on the second compared to the first simulation was observed for teaching communication skills for BBN using VMC. There was also a small but statistically significant mean improvement in performance from the first to the second simulation for the training overall. This work suggests that a deliberate practice model can be effective for teaching VMC and that a performance evaluation can be used to measure improvement. Further study is needed to optimize the teaching and evaluation of these skills as well as to define minimal acceptable levels of competency.

Cancer nurses’ perspective of error disclosure from nurses to patients: A qualitative descriptive study

PurposeThis study aims at exploring Cancer Nurses’ Perspective of Error Disclosure. MethodsThis qualitative descriptive study was conducted in 2022, Iran. Data collection methods included observation (121 h), and semi-structured interviews (12 interviews with nurses, and nursing managers). Data analysis was performed using Graneheim and Lundman's approach. This study obtained ethical approval from Ethics Committee of Isfahan University of Medical Sciences. The COREQ checklist was used for study report. ResultsData analysis resulted in three categories and nine subcategories: Error disclosure as a professional necessity (error disclosure as one of the patient's rights and error disclosure for self-and peer-learning), Error disclosure barriers (cancer-related factors, individual deterrents, nurses' intragroup culture, and organizational deterrents) and Error disclosure facilitators (culture of transparency, managerial support for error disclosure and development of error disclosure protocol). ConclusionCreating a culture of error disclosure requires removing barriers, and providing facilitators. By reevaluating their professional performance and responsibilities, nurses may help foster a culture of error disclosure, and managers can do the same by encouraging employees and creating a clinical error disclosure manual. The promotion of an error disclosure to the patient culture may be greatly aided by managers. They facilitate this role by providing practical guidance (based on Iranian culture, needs and conditions of cancer patients and their families) to address nurses' concerns about managers' and the organization's negative responses.