Hospital Disclosure Practices: Results Of A National Survey

Abstract

New patient safety standards from JCAHO that require hospitals to disclose to patients all unexpected outcomes of care took effect 1 July 2001. In an early 2002 survey of risk managers at a nationally representative sample of hospitals, the vast majority reported that their hospital's practice was to disclose harm at least some of the time, although only one-third of hospitals actually had board-approved policies in place. More than half of respondents reported that they would always disclose a death or serious injury, but when presented with actual clinical scenarios, respondents were much less likely to disclose preventable harms than to disclose nonpreventable harms of comparable severity. Reluctance to disclose preventable harms was twice as likely to occur at hospitals having major concerns about the malpractice implications of disclosure.T e ll i n g pat i e n ts a b o u t u nan t i c i pat e d o u tc o m e s of care is an established ethical expectation for physicians and nurses. 1 However, decisions about the appropriateness, timing, and content of disclosure have traditionally remained a private matter, left to the preferences of individual clinicians and health care institutions. Advances in informed-consent law and patients' rights over the past thirty years appear to have had little demonstrable impact on providers' willingness to disclose information about errors and adverse outcomes. 2 Today providers face new constraints in the area of disclosure. The Institute of Medicine's (IOM's) 1999 report, To Err Is Human, prompted calls for greater transparency in health care. 3 In July 2001 the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) responded by introducing new patient safety standards, including a requirement that all unanticipated outcomes of care be disclosed. 4 Although the requirement itself does not specify the need to disclose poor

The Many Faces of Error Disclosure: A Common Set of Elements and a Definition

“…Because this behavior occurs infrequently [10][11][12][13][14][23][24][25] and because we wanted to stimulate discussion and hear a range of experiences, focus groups 26 were used to explore this topic.…”

“…[10][11][12][13][14] When disclosure does take place, patients' expectations are often not met. 15,16 Disclosure of medical errors to patients and families is widely endorsed by medical professional associations, ethicists, and patient safety experts.…”

Apologies and Medical Error

“…Perhaps the most commonly cited barrier to disclosure and apology by physicians and risk managers is fear of litigation or legal liability [13,30]. At the same time, however, the link between the risk of litigation and willingness to disclose has not been established.…”

“…This suggests that although disclosure and apology may result in an increased volume of claims [49], total costs may decrease. Other hospitals (for example, University of Michigan Health System, Johns Hopkins, Children's Healthcare of Atlanta, Boston's Dana Farber Cancer Institute, and Massachusetts' Sturdy Memorial Hospital) as well as private insurers (eg, COPIC) report similar experiences [12,30,61].…”

"I'm Sorry" Laws and Medical Liability

“…Medical malpractice premiums have skyrocketed in recent years, most significantly in specialties such as obstetrics-gynecology and neurosurgery, and as a result many physicians fear that every patient is a potential litigant [2]. Two national surveys designed to assess attitudes toward disclosure revealed that fear of litigation was the primary reason for both physicians' and hospitals' reluctance to disclose errors and unanticipated outcomes [3,4].…”