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AAP urges institutional policies for disclosing adverse events to patients

A joint policy statement released by the AAP’s Committee on Medical Liability and Risk Management and Council on Quality Improvement and Patient Safety encouraged institutions and pediatricians to develop guidelines for disclosure of adverse events to patients.

While pediatricians generally agree that they have an ethical obligation to inform patients and their families following medical errors (MEs) and preventable adverse events (AEs), provider fear of liability continue to hinder full disclosure.

“[Adverse events (AEs)] not only affect patients and their families but also may have devastating effects on health care providers, who may suffer emotional consequences both from preventable AEs and from subsequent malpractice litigation,” William M. McDonnell, MD, JD, former chair of the Committee on Medical Liability and Risk Management and associate professor in the division of emergency medicine at University of Nebraska Medical Center, and colleagues wrote.

“Affected clinicians may feel guilt, shame and isolation, and these feelings may be exacerbated by negative reactions from their colleagues. Anticipated or actual punitive consequences can add additional emotional and financial burdens on providers.”

The perceived legal risks as well as longstanding legal advice cautioning against disclosures may represent the most significant barriers to provider discussions regarding AEs. For instance, legal protection for disclosures and provider apologies to patients vary from state to state, and, under some legislatures, an apology could be depicted as an admission of personal fault.

“Disclosure and open communication with patients and their families after an AE may provide benefit to the patient and to the health care provider, reduce consequential harms, allow for better follow-up, and promote a safety culture,” McDonnell and colleagues wrote. “Additionally, patients and caregivers most often desire complete disclosure of AEs and may be less likely to pursue litigation against their health care providers if complete disclosure is done.”

To protect pediatricians from unnecessary and inappropriate medical liability, the AAP provided recommendations for facilitating improved disclosure communication as well as provider education regarding disclosure of preventable AEs:

• Protocols for identifying and disclosing AEs to patients and families in an honest and empathetic manner as part of a nonpunitive culture of ME reporting should be developed and implemented;
• Clinicians and practices are encouraged to develop and implement policies to provide emotional support for clinicians involved in AEs;
• Pediatric medical educators are urged to develop mandatory educational programs regarding identification and prevention of MEs and communication about AEs with patients and their families as part of a comprehensive patient safety curriculum;
• Additional research for consequences of approaches to disclosure and disclosure education efficacy; and
• Continued development of apology laws and other mechanisms by state legislatures and other governmental and regulatory authorities to reduce liability risks associated with disclosure.

“There is little doubt that patients, families, and physicians are better served when full and honest communications can take place after AEs,” Williams and colleagues wrote. “The AAP and its members can help to promote such communications by becoming informed about, and encouraging, state apology laws and other public policies that support disclosure.” – by Kate Sherrer

Disclosure: The researchers report no relevant financial disclosures.