The Apology and Disclosure Grand Rounds NWH incorporates a video simulated error and a presentation about “When Things Go Wrong”. The presentation discusses disclosure coaching & peer support, the emotional impact of errors on clinicians, and principles for transparent & compassionate disclosure and apology.

Background: The emotional impact of medical errors on patients may be long-lasting. Factors associated with prolonged emotional impacts are poorly understood.

Methods: The authors conducted a subanalysis of a 2017 survey (response rate 36.8% [2,536/6,891]) of US adults to assess emotional impact of medical error. Patients reporting a medical error were included if the error occurred ≥ 1 year prior. Duration of emotional impact was categorized into no/short-term impact (impact lasting < 1 month), prolonged impact (> 1 month), and especially prolonged impact (> 1 year). Based on their reported experience with communication about the error, patients’ experience was categorized as consistent with national disclosure guidelines, contrary to guidelines, mixed, or neither. Multinomial regression was used to examine associations between patient factors, event characteristics, and organizational communication with prolonged emotional impact (> 1 month, > 1 year).

Results: Of all survey respondents, 17.8% (451/2,536) reported an error occurring ≥ 1 year prior. Of these, 51.2% (231/451) reported prolonged/especially prolonged emotional impact (30.8% prolonged, 20.4% especially prolonged). Factors associated with prolonged emotional impact included female gender (adjusted odds ratio 2.1 [95% confidence interval 1.5–2.9]); low socioeconomic status (SES; 1.7 [1.1–2.7]); physical impact (7.3 [4.3–12.3]); no organizational disclosure and no patient/family error reporting (1.5 [1.03–2.3]); communication contrary to guidelines (4.0 [2.1–7.5]); and mixed communication (2.2 [1.3–3.7]). The same factors were significantly associated with especially prolonged emotional impact (female, 1.7 [1.2–2.5]; low SES, 2.2 [1.3–3.6]; physical impact, 6.8 [3.8–12.5]; no disclosure/reporting, 1.9 [1.2–3.2]; communication contrary to guidelines, 4.6 [2.2–9.4]; mixed communication, 2.1 [1.1–3.9]).

Conclusion: Prolonged emotional impact affected more than half of Americans self-reporting a medical error. Organizational failure to communicate according to disclosure guidelines after patient-perceived errors may exacerbate harm, particularly for patients at risk of health care disparities.

WEBINAR DATE: July 16, 2020

This webinar outlines the concerns and questions about the collision between the judicial system and its pathway to addressing medical error and CRP programs.

PRESENTERS: Cindy Jacobs, RN, JD

OBJECTIVES:

1. Describe the basics of how the tort system operates in a medical error/adverse outcome situations
2. Describe the basics and how, when, and why CRP “apology laws,” “mandatory disclosure” laws/requirements, and healthcare licensing systems intersect and/or collide with the tort system
3. Identify key points to assist healthcare professionals in navigating intersections and collisions

The Communication and Optimal Resolution (CANDOR) process is a patient-centered approach used by health care institutions and practitioners to respond in a timely, thorough, and just way when unexpected patient harm events occur. It focuses on early disclosure of adverse events and a proactive method to achieving an amicable resolution for the patient/family and health care providers.

The video demonstrates an example of the care team’s disclosure meeting conversation with the affected family.

Discerning complicated approach of ethics and professionalism in medicine can be difficult. It’s similarly challenging when clinicians have to navigate through clinical or relational situation and develop an understanding of ethical, legal and more issues.

The Case Files consist of carefully crafted cases designed to stimulate proper approach and decision-making process. Case 18 focuses on transparent and compassionate disclosure and apology, and recognizing emotional challenged clinicians may face after an adverse event.

Physicians are urged to communicate more openly following medical errors, but little is known about pathologists’ attitudes about reporting errors to their institution and disclosing them to patients.The researchers of this article undertook a survey to characterize pathologists’ and laboratory medical directors’ attitudes and experience regarding the communication of errors with hospitals, treating physicians, and affected patients.

The importance of transparent and timely communication with patients following breakdowns in care is widely recognized. This article seeks to gain better understanding of breast cancer care providers’ attitudes regarding communicating with patients about diagnostic errors in order to inform interventions and to improve patient-provider discussions. Discussions focused on providers’ experiences with potential errors in breast cancer diagnosis, communication with patients following three hypothetical diagnostic vignettes, and suggestions for how and why diagnostic errors in breast cancer care should be communicated.
 

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.

Greater openness with patients about harmful errors is recommended. Many ethicists and professional organizations endorse disclosure of harmful errors to patients.The Joint Commission’s accreditation standards now require that patients be informed about unanticipated outcomes. In response, many hospitals are developing disclosure programs. Yet, recent studies suggest that disclosure of harmful medical errors to patients is the exception
rather than the rule. This article explores radiologists’ attitudes about disclosing errors to patients by using a survey with a vignette involving an error interpreting a patient’s mammogram, leading to a delayed cancer diagnosis.

Medical errors are unfortunately common. In the United States, Institute of Medicine proposed a set of guidelines for mitigating and disclosing errors. In order to implement these recommendations in pathology, it will require a better understanding of how errors occur in pathology, the relationship between pathologists and treating clinicians in reducing error, and pathologists’ experiences with and attitudes toward disclosure of medical error.This article aims to understand pathologists’ attitudes toward disclosing pathology error to treating clinicians and patients.

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.

Momentum has grown around turning the principle of being transparent with patients about harmful errors into practice. Most radiologists remain profoundly uncomfortable with the prospect of talking with patients about errors. This article describes recent developments driving widespread disclosure and apology efforts in the United States and looks at encouraging radiologists to prepare to discuss errors directly with patients.

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

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

Communication breakdowns in cancer care are unfortunately common and represent a failure in patient-centered care. While multiple studies have elicited patients’ perspectives on these breakdowns, little is known about cancer care providers’ attitudes regarding the causes and potential solutions. The purpose of this article is to examine providers’ (1) perceptions of the nature and causes of communication breakdowns with patients in cancer care and (2) suggestions for managing and preventing breakdowns.

Expectations for how radiologists should communicate with patients are in rapid evolution. Of all the communication challenges radiologists may encounter, disclosing harmful radiologic errors to patients looms as perhaps the most difficult. Calls are increasing for radiologists to communicate directly and transparently with patients after errors. This article explores the direct radiologist-to-patient disclosure of harmful radiologic errors. It further explores the profession’s aspirations toward enhanced patient care, professionalism, and visibility.

This article describes recommendations that extend existing guidelines for clinicians and institutions on communicating with patients about colleagues’ harmful errors.

Dr. Shapiro talks about the importance of having disclosure coaching program and fundamental principles of disclosure coaching. For more videos related to Disclosure and Apology, view the video gallery.

This research article explores the use of a video-based communication assessment app to evaluate physician error disclosure skills. The study uses the generalizability theory to assess the reliability of crowdsourced laypeople and patient advocates in rating these skills, utilizing the Video-Based Communication Assessment app, which has not yet been evaluated for its effectiveness in medical harm scenarios. The researchers conducted a comparative analysis of crowdsourced laypeople and patient advocates as raters of physician error disclosure communication skills. The results of this study demonstrate that crowdsourced laypeople have the potential to provide reliable assessments of physician error disclosure skills. However, further research is necessary to explore the app’s effectiveness in different assessment scenarios.

This consensus paper of the Harvard-affiliated hospitals was prepared by clinicians, risk managers, and patients to provide an in-depth understanding of preventable adverse events, their impact on patients, families, and providers, and how to manage such events. The report provides detailed guidelines based on the premise that all care should be safe and patient-centered and that all actions require full disclosure. In addition to offering recommendations on how to effectively communicate with patients and families, the report discusses support for caregivers and a detailed strategy for institutions to respond to such events in a timely and appropriate fashion. Finally, the comprehensive report offers several appendices that include recommendations and a case study on communicating with patients and families.