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Medically injured patients desire to know more about prevention efforts
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Although 60% of patients and family members were satisfied with communication-and-resolution programs after medical injury, their need to be heard and to know about efforts to prevent recurrences often were unmet, according to findings published in JAMA Internal Medicine.
“The misery of medical malpractice litigation for all involved has made hospitals keenly interested in resolving medical injuries with patients before claims are filed,” Jennifer Moore, LLB, MA, PhD, of the University of New South Wales in Sydney, Australia, and colleagues wrote. “Among the strategies receiving attention are communication-and-resolution programs (CRPs), in which hospitals disclose adverse events, investigate, apologize, explain what happened and, when appropriate, proactively offer compensation.”
Moore and colleagues sought to evaluate patients’ and family members’ experiences with CRPs to better understand how different institutional responses to injury promote or impede reconciliation. The researchers conducted semistructured interviews between January 6 and June 30, 2016, with 27 patients, three family members and 10 staff members at three hospitals in the United States. Using CRP databases, the CRP administrators identified eligible patients and families who participated in a CRP, spoke English and were unable to file a malpractice claim because settlement was accepted or the statute of limitations had expired. Hospital and insurer staff who participated in a CRP event and had a relationship with the injured patient and/or family were also identified.
Data indicated that all 27 patients received compensation for medical error related injuries.
Overall, 18 patients and family members had a positive experience with CRP and continued to receive care at the hospital. Empathetic and nonadversarial communications, including negotiations for compensation, resulted in the highest levels of satisfaction. In the interviews, patients and families emphasized a strong need to be heard without interruptions. A majority of respondents (35 of 40) reported that it was helpful to include plaintiffs’ attorneys in these discussions.
Compensation was deemed adequate by 16 of the 60 patients and family members; however, 17 did not believe that the offer was adequately proactive. There was a strong desire from patients and families to understand the measures that the hospital took to prevent recurrences of the event, yet most (24 of 30) did not receive information regarding safety improvement efforts.
“As hospitals strive to provide more patient-centered care, opportunities exist to improve the care that is provided after an adverse event,” Moore and colleagues concluded. “Even in hospitals with deep commitments to operating CRPs that serve patients’ needs, only 18 of 30 patients and family members reported positive overall experiences. The CRP movement is young with much room to grow. Listening to patients illuminates the way forward.”
In a related editorial, Kathryn Zeiler, JD, PhD, from Boston University School of Law, wrote that injury data is needed to determine if CRPs can achieve their implied potential.
“Clinicians are motivated to deliver high quality care by factors other than the liability system. They care about their patients,” she wrote. “Patient outcomes shape their self-worth and reputations. Despite this, injury rates remain high. Communication-and-resolution programs have potential to reduce them, surpassing the chance that the underused liability system offers. Evaluation of the effect of CRPs on injury rates seems to be a good and necessary next step.” – by Alaina Tedesco
Disclosures: Moore and Zeiler report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Albert W. Wu, MD, MPH
It is a normal and perhaps primal human response to expect an apology after a perceived wrong or injury. This is true for something as trivial as when someone accidentally bumps into you on the street. Patients naturally expect honest disclosure and an apology after a medical injury.
Practicing clinicians need to appreciate this, as it makes it easier for them to acknowledge their obligation to disclose adverse events to patients and/or families. However, it is important for clinicians and administrators to be aware that incidents that harm patients can simultaneously harm the doctors, nurses and others who are involved.
The belief that you have harmed a patient can have short- and long-term emotional and behavioral effects for any clinician. Clinicians often experience feeling numb, anxious and depressed, or they may suffer from insomnia, poor concentration and memory problems. They may feel shame and self-doubt, or fear that they have lost the respect of their colleagues.
In a busy clinical environment, there is often little time for individuals to come to terms with the situation. Some of these clinicians find their professional performance is also impaired. Ironically, this can increase the risk of additional errors. In a few cases, the experience can become a chronic stressor and progress to symptoms of post-traumatic stress disorder. In extreme cases, it can lead to good clinicians leaving practice — or worse.
For this reason, it is crucial that clinicians and health care institutions be aware of the issue of second victims, and ensure that there are structures in place to provide emotional support to clinicians after patient adverse events. The RISE program at Johns Hopkins is one example. This can mean the difference between clinicians coping with the incident and returning to full productivity or their being unable to do so.
An added stress on clinicians is the fear of disclosing the incident to the patient or family, as well as potential medico-legal repercussions. With increased clarity about the obligation to disclose incidents to patients, such as was provided by the article in JAMA Internal Medicine, there is increased urgency to provide practical support to clinicians to carry out these discussions. There is also increased urgency to ensure adequate support for clinicians in these difficult situations.
References:
Wu AW. BMJ. 2000;doi:10.1136/bmj.320.7237.726.
Edrees H, et al. BMJ Open. 2016;doi:10.1136/bmjopen-2016-011708.
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