Patient Safety and Quality

Full disclosure of medical errors to patients is becoming more and more transparent

The medical profession is transforming how to communicate and discuss incidents of medical errors with patients. Within a decade, it is possible that full disclosure of errors to patients will be the norm rather than the exception, according to University of Washington researcher Thomas H. Gallagher, M.D., and colleagues in a recent commentary.

Until recently, health care professionals have had little guidance on how or when to disclose medical errors. Professional societies merely noted that disclosure was an ethical obligation. However, in 2001 the Joint Commission on Accreditation of Healthcare Organizations issued the first nationwide disclosure standard that requires that patients be informed about medical errors. By 2005, 69 percent of health care organizations had established disclosure policies, which ranged from simple statements to detailed disclosure procedures.

In 2006, the National Quality Forum (NFQ) endorsed a new safe-practice guideline on the disclosure of serious unanticipated outcomes to patients, which encourages hospitals to integrate their risk-management, patient-safety, and quality improvement programs. The guideline also calls for appropriate staff training in disclosure conversations as well as coaching health care workers just before a disclosure. The 29 large health care purchasing coalitions in the Leapfrog Group use the NQF guideline as a standard in their pay-for-performance program, which publishes facility compliance on the Internet. Finally, there are the legal ramifications of admitting responsibility for medical error. A flurry of laws concerning disclosure have been proposed or enacted at the State and Federal levels. There is considerable speculation and debate about the impact of disclosure on litigation.

Although disclosure may quell some patients' interest in litigating, it will ignite interest in others. Eventually, most organizations will probably provide disclosure training for their health care workers and more intensive training for frontline clinicians, conclude the researchers. Their study was supported in part by the Agency for Healthcare Research and Quality (HS14012).

More details are in "Disclosing harmful medical errors to patients," by Dr. Gallagher, David Studdert, L.L.B., Sc.D., M.P.H., and Wendy Levinson, M.D., in the June 28, 2007, New England Journal of Medicine 356(26), pp. 2713-2719.

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