Researchers advise medical care groups to report multiple medical errors

GHN News - As medical errors continue to rise, there are recommendations from researchers to help organizations make sure those errors involving multiple patients are disclosed.

The rate of medical error and type are more and more being disclosed to

patients even if they were not harmed by the event.  These events
include not using completely sterilized equipment, exhibiting poor
laboratory control, and equipment malfunctions that can impact the
patient.  The problem is there is not sufficient disclosure about
multiple incidents.

"It's clear that
health care organizations face a dilemma regarding disclosure of
large-scale adverse events – whether these events lead to patient harm
or not," said AHRQ Director Carolyn M. Clancy,
M.D. "It's not always clear how to do that in a way that minimizes risk
to the patient and the organization, but this research can help."

According to researchers from the University of Washington, Seattle,
hospitals and medical centers are reluctant to disclose problems that
have affected many patients.  There are concerns about the psychological
implications in doing so, but the researchers conclude that in most
cases these events should be disclosed.

These are the recommendations offered on how to make those disclosures:

• "Develop an institutional policy.
  Organizations should have a clear set of procedures for managing the
  disclosure process, notifying patients and the public, coordinating
  follow-up diagnostic testing and treatment and responding to regulatory
  bodies.


• Plan for disclosures.
  Disclosures should be made proactively, unless a strong, ethically
  justifiable argument can be made not to do so. The method of disclosure
  may depend on the event, but patients should be informed personally and
  all at the same time.


• Communicate with the public.
  Organizations should assume that media coverage of a large-scale
  adverse event is inevitable. To build public trust, media responses
  should demonstrate the organization's commitment to honesty and
  transparency.


• Plan for patient follow-up.
  Organizations should provide follow-up diagnostic testing and treatment
  to patients affected by the LSAE and address any anxiety caused by the
  disclosure. Patients who have suffered physical harm due to an event
  resulting from a preventable error or system failure should be
  compensated."

Lead  author Denise Dudzinski, Ph.D., an associate professor in the Department of Bioethics & Humanities at the University of Washington explains it is important to have the public trust, which is an essential reason for full disclosure.

"These
disclosures are never easy, but it is critical that organizations invest
the time and resources necessary to learn how to handle these
disclosures effectively,"  concludes researchers.

Problems in Medicine: physician incompetence , under reporting, errors

 

[caption id="attachment_10735" align="alignleft" width="300" caption="Doctors sethoscope"][/caption]

Carol Forsloff - Attorneys often claim when they are involved in a lawsuit with a doctor, that physicians hang together when it comes to testifying against each other or even supporting patient claims of bad medicine against a doctor, and new research supports to some extent that is true. 




In a survey of doctors, most doctors were found to support the idea of reporting incompetent or impaired folks in the medical profession but when faced with doing so many do not follow through.  

“Many states have mandatory reporting statutes, requiring physicians and other health care professionals to report to appropriate authorities those physicians whose ability to practice medicine is impaired by alcohol or drug use or by physical or mental illness,” researchers say.  

Data  shows the rate of reporting is significantly lower than it should be, given what is said to be the estimated numbers of physicians who become impaired or who are otherwise incompetent to practice. 

Catherine M. DesRoches, Dr.P.H., of Massachusetts General Hospital, Boston, and colleagues did a study to examine doctor's beliefs, actual experiences and level of preparedness involving impaired or incompetent physicians in a survey of 1,891  physicians practicing in the United States in 2009.  The results tell the story of how physicians actually respond when faced with having to file a report. 

The survey found 64 percent of those surveyed agreed that impaired or incompetent physicians should be reported and 17 percent said they had actual knowledge of someone in their group with these issues but only 67 percent of these doctors actually filed a report about their colleagues or others they knew had impairments in the practice of medicine. 

Minority physicians were significantly less likely than other physicians to report, as were international medical graduates compared with graduates of U.S. medical schools.   Big city doctors were more likely to report than those in small practices. 

Most physicians said the reason they didn't report is they felt someone else was handling the problem, along with believing nothing would happen if they did file a report or that there would be retribution. 

“These national data regarding physicians’ beliefs, preparedness, and actual experiences related to impaired and incompetent colleagues raise important questions about the ability of medicine to self-regulate. More than one-third of physicians do not completely support the fundamental belief that physicians should report colleagues who are impaired or incompetent in their medical practice. This finding is troubling, because peer monitoring and reporting are the prime mechanisms for identifying physicians whose knowledge, skills, or attitudes are compromised,” the researchers say. 

These statistics, when combined with the growing rate of medical errors found in research done over the past ten years shows a serious issue in medicine, according to those involved in collecting the data.  The Institute of Medicine looked at the problem in 1999 and found this:

"Between 45,000 and 98,000 Americans die each year as the result of medical errors. If the lower figure is used as an estimate, deaths in hospitals resulting from medical errors are the eighth leading cause of mortality in the United States, surpassing deaths attributable to motor vehicle accidents (43,458), breast cancer (42,297), and AIDS (16,516). Moreover, these figures refer only to hospitalized patients; they do not include people treated in outpatient clinics, ambulatory surgery centers , doctors' or dentists' offices, college or military health services, or nursing homes . Medical errors certainly occur outside hospitals; in 1999, the Massachusetts State Board of Registration in Pharmacy estimated that 2.4 million prescriptions are filled incorrectly each year in that state—which is only one of 50 states.

In the case of physician involvement in reporting incompetence, some of the suggestions for improving physician reporting made by the researchers , as published in the latest edition of JAMA, include strengthening external regulation, making sure reporting systems protect confidentiality and to make sure that those who do report get confidential feedback of the outcomes of any actions taken. 

“All health care professionals, from administrative leaders to those providing clinical care, must understand the urgency of preventing impaired or incompetent colleagues from injuring patients and the need to help these physicians confront and resolve their problems. The system of reporting must facilitate, rather than impede, this process. Reliance on the current process results in patients being exposed to unacceptable levels of risk and impaired and incompetent physicians possibly not receiving the help they need,” the authors conclude.