Frequency, Expected Effects, Obstacles, and Facilitators of Disclosure of Patient Safety Incidents: A Systematic Review

Abstract

ObjectivesWe performed a systematic review to assess and aggregate the available evidence on the frequency, expected effects, obstacles, and facilitators of disclosure of patient safety incidents (DPSI).MethodsWe used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for this systematic review and searched PubMed, Scopus, and the Cochrane Library for English articles published between 1990 and 2014. Two authors independently conducted the title screening and abstract review. Ninety-nine articles were selected for full-text reviews. One author extracted the data and another verified them.ResultsThere was considerable variation in the reported frequency of DPSI among medical professionals. The main expected effects of DPSI were decreased intention of the general public to file medical lawsuits and punish medical professionals, increased credibility of medical professionals, increased intention of patients to revisit and recommend physicians or hospitals, higher ratings of quality of care, and alleviation of feelings of guilt among medical professionals. The obstacles to DPSI were fear of medical lawsuits and punishment, fear of a damaged professional reputation among colleagues and patients, diminished patient trust, the complexity of the situation, and the absence of a patient safety culture. However, the factors facilitating DPSI included the creation of a safe environment for reporting patient safety incidents, as well as guidelines and education for DPSI.ConclusionsThe reported frequency of the experience of the general public with DPSI was somewhat lower than the reported frequency of DPSI among medical professionals. Although we identified various expected effects of DPSI, more empirical evidence from real cases is required.

The relationship of moral sensitivity and patient safety attitudes with nursing students’ perceptions of disclosure of patient safety incidents: A cross-sectional study

“…Open disclosure maintains trust between healthcare providers and patients, reduces medical disputes, and decreases medical malpractice claims [3]. Healthcare providers favor open disclosure programs and are more likely to continue to work at institutions which encourage them [5].…”

Understanding Implementation of Patient Safety Goals Framework at Inpatient Unit of Ciracas General Hospital, Indonesia

“…Information on patient safety should be reproduced more and should not only be oral but written will be better [18,19]. This information can be in the form of banners, posters, multimedia (patient safety promotional videos) or other information related to the definition of patient safety so that both officers and patients/family/visitors of the inpatient unit will always be able to read and at least understand first what is meant by patient safety [20].…”

Korean physicians’ perceptions regarding disclosure of patient safety incidents: A cross-sectional study

“…Previous studies have investigated perception of various barriers to DPSI, such as fear about medical lawsuits and disciplinary actions or loss of trust from patients and colleagues [4], but almost no questionnaire surveys have asked questions about the possibility of uneven burden of demanding DPSI in the medical field but not, or in relation to, other fields. The findings of the present study are believed to have been influenced by dissatisfaction physicians feel toward government policies and the burden of societal demand for high ethical standards.…”

“…"When a patient safety incident occurs, medical professionals preemptively explain the incident to the patients and their caregivers, express sympathy and regret for the incident, deliver an apology and compensation appropriately if needed, and promise to prevent recurrence [2]." The emphasis on DPSI in the field of patient safety is based both on ethical considerations [1,3] and on various known beneficial effects including reduced number of medical lawsuits and related costs; reduced intention to discipline medical staff; stronger physician-patient relationships; increased intention to revisit and recommend medical staff; higher assessment scores for quality of care; and reduced guilt among medical staff [4].…”

“…Medical staffs are reluctant to perform DPSI even under situations when DPSI is needed due to fears about medical lawsuits and disciplinary actions, as well as about losing the trust of patients and colleagues [4]. In particular, among physicians, who are in the most critical position with regard to performing DPSI, not having accurate perceptions of DPSI and doubting its effects and benefits act as a major barrier to proper execution of DPSI [2].…”