Error Disclosure

Medically Induced Trauma Support Services (MITSS), Inc-a non-profit organization whose mission is To Support Healing and Restore Hope to patients, famihes and dinidans who have been affected by an adverse medical event. Set up by Linda Kenney, who experienced an error and nearly died, and Rick van Pelt, an anaesthetist. The organization is aimed at promoting honesty, error disclosure and support for traumatized patients. 

Liang, B. A. System of Medical Error Disclosure. [http //qhc.bmjjournals.com/cgi/ content/fuU/11/1/64] Quality and Safety in Health Care, 2002, 77(1), 64-68. 

The American College of Physicians and American Society of Internal Medicine suggests disclosing if it is material to the patient s weU-being. The AMA advises error disclosure whenever major medical complications occur. The Joint Commission criterion is for any unanticipated outcome. The NPSF bases the disclosure threshold on any injury occurrence. Use a predetermined error threshold. 

The ethics of open disclosure of errors are crystal clear and expressed in many clinical codes of ethics. Here is an example from the American Medical Association ... 

From the little information available, it does seem clear that those organizations that have followed the path of open disclosure have not been overwhelmed by lawsuits. To the contrary, the experience has been positive and they have argued strongly for others to follow. One hospital in the United States initiated a policy of open disclosure in 1987, deciding to both take a more proactive approach to managing defensible claims and also to come forward and acknowledge when a serious error had been made. This commendable ethical position has led to five major settlements over the years of cases where... 

Cleopas, A., Villaveces, A., Charvet, A.eta/. (2006) Patient assessments of a hypothetical medical error effects of health outcome, disclosure, and staff responsiveness. Quality... 

Gallagher, T.H., Waterman, A.D., Bbers, A.G. et al. (2003) Patients and physicians attitudes regarding the disclosure of medical errors. Journal of the American Medical Association, 289(8), 1001-1007. 

Mazor, K.M., Reed, G.W., Yood, R.A. et al. (2006) Disclosure of medical errors what factors influence how patients respond Journal of General Internal Medicine, 21(7), 704-710. 

Schwappach, D.L. and Koeck, C.M. (2004) What makes an error unacceptable A factorial survey on the disclosure of medical errors. International Journal for Quality in Health Care, 16(4), 317-326. 

Provide clear guidelines for discussion of error with patients backed up by board level policy on open disclosure. 

Wolf, Z. R., Hughes, R. G., Error Reporting and Disclosure, in Patient Safety and Quality An Evidence-Based Handbook for Nurses, edited by R. G. Hughes, Agency for Healthcare Research and Quality, Rockville, Maryland, 2008, Chapter 35, pp. 1 7. 

The NPSA idenhfies patient safety-associated deficiencies with the aid of input from pahents and clinical experts, develops appropriate solutions, and monitors results of correchve measures within the NHS. Its initiatives and alerts include items such as hand hygiene, information for doctors and patients on steps to decrease risk of error, vaccine safety, and disclosure of error to all injured patients. Finally, the National Reporting and Learning System (NRLS) allows all NHS employees to provide the NPSA with reports on an anonymous basis. 

Changing responses to medical accidents and errors, including the development of disclosure policies... 

Nevertheless, more and more organizations are developing disclosure policies and preparing professionals to inform patients and their families about errors that have caused harm and about what will be done to prevent future errors. For example, Victoria Frazier, a physician and advocate of the patient safety movement in the Barnes Jewish Hospital System and at Washington University Medical Center in St. Louis, is studying accountability with respect to medical accident and is a leader in research identifying evidence-based approaches to disclosure (Frazier, 2003). 

We used to think that individual human error was a major cause of medical accidents. We learned that this is rarely the case. The human tendency to assign error as cause and place blame is universal and cross-cultural, a tremendous barrier to safety. When an accident does occur, aU the victims—the patient, the family, and the providers need support, disclosure, and accountable leadership. The focus of investigating accidents is on system breakdowns, not on individual error. 

Gallagher, T. H., Waterman, A. D., Ebers, A. G., Fraser, V J., and Levinson, W. Patients and Physicians Attitudes Regarding the Disclosure of Medical Errors. Journal of the American Medical Association, 2003, 289lfi), 1001—1007. 

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