The study was conducted gain a better understanding about the attitudes and experiences of breast cancer providers regarding communicating with patients about diagnostic error.

Highlights:

1. Providers more willing to inform patients of a diagnostic error when they felt it would be helpful.
2. Providers willing to inform patients of diagnostic error when feeling responsible for the error.
3. Providers willing to inform patients of diagnostic error if less concerned about litigation.
4. Providers more willing to inform patients of a diagnostic error when the patient asked directly.

This letter to the Editors emphasizes the importance of CRPs in allowing hospitals to learn from all adverse events, even those that may not be traced by loss adjusters, and that the benefits of CRPs exceed their potential to mitigate economic burdens, even during the challenging time of COVID-19.

The Sweet Law Firm in Oklahoma City, one of the Collaborative for Accountability and Improvement’s partners in promoting the spread of CRPs, has developed a COVID-19 Consent for Treatment/Procedure/Surgery form.

2020-04-24 Proposed COVID-19 Consent Form (Final)

Crisis Standards of Care (CSC) was developed in 2009 by the Institute of Medicine in response to consecutive catastrophic disasters happening around the world. The report provides a framework for a systems approach to the development and implementation of CSC plan that should apply in disaster or crisis situations. It was designed to help state and local public health officials and health-sector agencies and institutions operationalize CSC.

Institute of Medicine; Board on Health Sciences Policy; Committee on Guidance for Establishing Standards of Care for Use in Disaster Situations; Dan Hanfling, Bruce M. Altevogt, Kristin Viswanathan, and Lawrence O. Gostin, Editors

Researchers reviewed patterns in healthcare policies and trends in five countries (the United States, the United Kingdom, New Zealand, Australia, and Canada) with histories of disclosing adverse incidents to patients. The researchers wanted to analyze the barriers that prevent healthcare providers and institutions from disclosing adverse events to their patients. They concluded that some barriers included difficulties with liability fees, patients’ beliefs on safety in the healthcare setting, and implementing policy changes on a large-scale. Effective ways to combat these challenges include carrying out a long-term program that involves educating patients and healthcare workers about safety.

Despite the obvious need for open conversations with patients and their families following an adverse event, many organizations still lack the structure to support providers during this difficult time. In many cases, clinicians who have to disclose errors to patients and families fail due to lack of provider education and training, lack of confidence, fears of litigation and emotional distress.

The Ask-Tell-Ask Model focuses on successful disclosure coaching conversations. It includes:

1. Case Scenario
2. Key elements
3. Practical step-by-step strategies for disclosure coaching
4. Pedagogical model using the “Ask-Tell-Ask” approach
5. Organizational considerations for establishing a coaching program

This video focuses on principles and skills for effective disclosure conversations, especially around delayed cancer diagnosis, and includes a case example.

A short video of Dr. Shapiro speaking on disclosure of medical error to patients and families. This video is part of “Choosing Wisdom: The Path Through Adversity” documentary.

Early Discussion & Resolution (EDR) Conversation Guidance from Oregon Patient Safety Commission offers general guidance that can serve as a foundation in initiating conversations and follow ups.

An adverse event can gravely affect both patients and their families and providers. Having a conversation between healthcare providers and patients about the incident can bring resolution and closure.

Goals of EDR from Oregon Patient Safety Commission:

1. Prevent an unfortunate situation from escalating
2. Restore the keystone of healthcare—the provider-patient relationship
3. Bring greater peace of mind to everyone
4. Learn from events to improve patient safety

Many organizations have struggled to implement CRP models smoothly. The study looks at factors that accounts for the success of two Massachusetts hospital system in implementing a CRP with high conformity to protocol without raising liability costs. Identified factors include: support of top institutional leaders, heavy investments in educating physicians about the programme, active cultivation of the relationship between hospital risk managers.

Abstract

Radiology’s leaders in peer review, patient-centered care, quality and safety, legal affairs, and institutional processes can help prepare radiologists to communicate openly with patients and families about errors by spearheading dialog within the profession regarding how best to implement this emerging practice standard.

The video includes three scenarios to demonstrate how different approaches to disclosure can have an effect on the course of communication with a patient’s loved one.

Disclosure Scenarios:

1. Disclosure with No Apology
2. Disclosure with Apology of Sympathy
3. Disclosure with Apology or Responsibility

This guide for Getting Started with a CRP Policy or Commitment Statement outlines key elements and suggestions for developing an institutional CRP policy or commitment statement. It was developed by members of CAI’s Policy Committee in partnership with patient and family advocates.

Iowa’s Candor Statute – Iowa Code §135P (2017)

The Policy Committee works to educate and engage various groups on how to support CRP at the institutional, state, and federal level. This past year, the committee reached out to the National Practitioner Data Bank (NPDB) and to the Centers for Medicare & Medicaid Services (CMS).

The letter to NPDB is part of a continued conversation about efforts to expand alternatives to medical liability litigation.

The letter to CMS illustrates how CRPs are consistent with the principles of Person and Family Engagement.

Inconsistent CRP implementation and focus on claims savings rather than nurturing a culture of accountability results to missed opportunities for improving quality and safety. The article includes four suggested strategies for implementing and spreading authentic CRPs.

Publish Date: January 28, 2020

A systematic review of 37 studies of malpractice deterrence  published between January 1, 1990, and November 25, 2019 was conducted to examine the association between malpractice liability risk and health care quality and safety. This review found that most studies suggest that higher risk of malpractice liability is not significantly associated with improved health care quality. The findings also suggested that greater tort liability was not associated with the improvement of quality of care.

Publish Date: January 28, 2020

This issue presents a thorough and rigorous analysis of recent research and draws findings from 37 studies.  It conclude that increased liability exposure, such as numbers of malpractice claims or changes to state malpractice laws, was not associated with improvement in the quality of patient care.

MA 2012 Payment Reform Legislation (Ch 224) – Key Liability Provisions

The video demonstrates how medical professionals can talk about medical errors with the care team, patients and their families. It includes two disclosure scenarios and didactic lecture on disclosure.

Key points:

1. common emotional response
2. preparing for the conversation
3. the initial conversation
4. avoiding common mistakes
5. physician support

Oregon Resolution of Adverse Health Care Incidents Act (2013)

A Guide to Assist Health Departments and Healthcare Facilities with Conducting a Patient Notification Following Identification of an Infection Control Lapse or Disease Transmission

This article discusses the importance for healthcare organizations to understand the patient’s perspective after they received disclosure following an adverse medical event, because it could help them develop more effective communication methods. Researchers found that patients preferred it when healthcare systems disclosed adverse events to them. They also found that these systems should implement policies that promote disclosure between patients and physicians.

Improving how health care providers respond to medical injury requires an understanding of patients’ experiences. Although many injured patients strongly desire to be heard, research rarely involves them. Institutional review boards worry about harming participants by asking them to revisit traumatic events, and hospital staff worry about provoking lawsuits. Institutions’ reluctance to approve this type of research has slowed progress toward responses to injuries that are better able to meet patients’ needs. In 2015-2016, we were able to surmount these challenges and interview 92 injured patients and families in the USA and New Zealand. This article explores whether the ethical and medico-legal concerns are, in fact, well-founded. Consistent with research about trauma-research-related distress, our participants’ accounts indicate that the pervasive fears about retraumatization are unfounded. Our experience also suggests that because being heard is an important (but often unmet) need for injured patients, talking provides psychological benefits and may decrease rather than increase the impetus to sue. Our article makes recommendations to institutional review boards and researchers. The benefits to responsibly conducted research with injured patients outweigh the risks to participants and institutions.

Health care providers working on the front lines of the COVID-19 pandemic are threatened not only by exposure to the virus but also by pervasive and detrimental  effects on their mental health. Immediate actions need to be taken for a national strategy to safeguard the health and well-being of our clinicians. The article outlines 5 high-priority actions to protect the well-being of clinicians during and after COVID-19 crisis.

Written by: Victor J. Dzau, M.D., Darrell Kirch, M.D., and Thomas Nasca, M.D.

This is a tip sheet for healthcare leaders about how to create an environment for CRP to succeed.

Zerillo, Tardiff, Flood, Sokol-Hesner, and Weiss retrospectively coded 148 corrective actions from 67 safety events brought to a tertiary care academic medical center’s multidisciplinary hospital-level safety event review meeting from 2020 to 2021. They coded by category and strength, using the US Department of Veterans Affairs/Institute for Healthcare Improvement Action Hierarchy Tool. They found an inverse relationship between intervention strength and completion; the strongest interventions had the lowest rate of completion. Also, the majority of corrective actions were categorized as weak.

This article highlights the importance of developing systems for tracking the completion of corrective actions. Without tracking data on completion, organizations cannot know how well they are mitigating the risks to safety that their analyses have identified. By integrating action strength and completion status into corrective action follow-up, healthcare organizations may more effectively identify and address those barriers to completing the strongest interventions that ultimately achieve high reliability.

Dr. Jo Shapiro of Brigham and Women’s Hospital is interviewed about disclosure, peer support, and resilience following medical error on Ireland’s national public radio, RTÉ Radio 1 (July 9, 2017).

Serious Illness Care Program COVID-19 Response Toolkit by Ariadne Labs, first version was published on April 3, 2020.

Ariadne Labs, one of Collaborative for Accountability and Improvement’s partners in cultivating high-quality, patient-centered care, has developed the Serious Illness Care Program’s COVID-19 Response Toolkit to help clinicians with difficult conversations with high risk COVID-19 patients.

Table of Contents: 

1. COVID-19 Conversation Guide for Outpatient Care
2. Telehealth Communication Tips
3. Recommendation Aid
4. Care Planning Resources