Hospital disclosure practices: Results of a national survey

Health Affairs

Volumn 22, Issue 2, 2003, Pages 73-83

  Lamb, Rae M ^a   Studdert, David M ^b   Bohmer, Richard M J ^c   Berwick, Donald M ^d   Brennan, Troyen A ^b,e  

^a NZBS   (New Zealand)

^b HARVARD SCHOOL OF PUBLIC HEALTH   (United States)

^c HARVARD BUSINESS SCHOOL   (United States)

^d INSTITUTE FOR HEALTHCARE IMPROVEMENT   (United States)

^e HARVARD MEDICAL SCHOOL   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ACCREDITATION; ARTICLE; EPIDEMIOLOGY; HOSPITAL MANAGEMENT; HUMAN; INTERPERSONAL COMMUNICATION; LEGAL ASPECT; MEDICAL ERROR; PATIENT ADVOCACY; POLICY; SAFETY; STANDARD; STATISTICS; UNITED STATES;

HEALTH CARE SURVEYS; HOSPITAL ADMINISTRATION; HUMANS; JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANIZATIONS; MEDICAL ERRORS; ORGANIZATIONAL POLICY; PATIENT ADVOCACY; SAFETY MANAGEMENT; TRUTH DISCLOSURE; UNITED STATES;

EID: 0037363579     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.22.2.73     Document Type: Review

References (52)

1. American Medical Association, "Code of Medical Ethics: Current Opinions," 31 July 2002, www.ama-assn.org/ama/pub/category/2503.html (30 December 2002);
2. American College of Physicians, "Ethics Manual, Fourth Edition," Annals of Internal Medicine 128, no. 7 (1998): 576-594;
3. and American Nurses Association, "Code of Ethics for Nurses with Interpretive Statements," 2001, www.nursingworld.org/ethics/code/ ethicscode150.htm (30 December 2002).
4. T.A. Brennan, Just Doctoring: Medical Ethics in the Liberal State (Berkeley: University of California Press, 1991);
5. M.L. Millenson, Demanding Medical Excellence: Doctors and Accountability in the Information Age (Chicago: University of Chicago Press, 1997);
6. and L.M. Peterson and T.A. Brennan, "Medical Ethics and Medical Injuries: Taking Our Duties Seriously," Journal of Clinical Ethics 1, no. 3 (1990): 207-211.
7. L.T. Kohn, J.M. Corrigan, and M.S. Donaldson, eds., To Err Is Human: Building a Safer Health System (Washington: National Academy Press, 1999);
8. Institute of Medicine, Crossing the Quality Chasm: A New Health System for the Twenty-first Century (Washington: National Academy Press, 2001);
9. and White House Press Office, "Medical Errors Remarks by President Clinton," Press Release, 7 December 1999.
10. Joint Commission on Accreditation of Healthcare Organizations, Standard RI.1.2.2, 1 July 2001.
11. JCAHO, JCAHO press conference transcript, 2 July 2001, Atlanta, Georgia.
12. The Institutional Review Board at the Harvard School of Public Health approved both the survey and the study design.
13. The four clinical scenarios were (1) preventable event with serious outcome (a patient suffers a catastrophic hemorrhagic cerebrovascular accident following heparin pump failure that causes heparin overdose); (2) nonpreventable event with serious outcome (patient with no known drug allergies dies as a result of anaphylactic shock secondary to ampicillin); (3) preventable event with minor outcome (coumadin overdose leads to elevated prothrombin time and two additional, otherwise unnecessary, hospital days); and (4) nonpreventable event with minor outcome (patient with no drug allergies develops rash and itching secondary to antibiotic reaction).
14. VA hospitals were excluded from both strata. We also removed seven hospitals from the sampled group: Six were in Puerto Rico, and one had specially requested exclusion.
15. J. Rosenthal et al., State Reporting of Medical Errors and Adverse Events: Results of a Fifty-State Survey (Portland, Maine: National Academy for State Health Policy, 2000). Utah has a Patient Safety Sentinel Event Reporting Rule R380-200-3, effective 15 October 2001.
16. Of the 338 total replies we received, ninety-three were refusals to complete the full survey, with twenty-five of these citing as their primary reason that they or others at their institution had legal concerns about doing so. An additional eighteen of the refusers said they were too busy, fifteen said that they did not participate in surveys, and ten said it was too early in the development of their disclosure policies to answer our questions.
17. The dependent variable in this multivariate model was propensity to disclose preventable harm, as determined by responses to the clinical scenarios. The independent variables were malpractice concerns, AMC status, ownership, number of beds, reporting law environment, and region.
18. E.J. Thomas et al., "Incidence and Types of Adverse Events and Negligent Care in Utah and Colorado," Medical Care 38, no. 3 (1999): 261-271;
19. and T.A. Brennan et al., "Incidence of Adverse Events and Negligence in Hospitalized Patients: Results of the Harvard Medical Practice Study I," New England Journal of Medicine 324, no. 6 (1991): 370-376.
20. B.A. Liang, "Error in Medicine: Legal Impediments to U.S. Reform," Journal of Health Politics, Policy and Law 24, no. 1 (1999): 27-58;
21. L. Gostin, "A Public Health Approach to Reducing Error: Medical Malpractice as a Barrier," Journal of the American Medical Association 283, no. 13 (2000): 1742-1743;
22. A.W. Wu, "Handling Hospital Errors: Is Disclosure the Best Defense?" Annals of Internal Medicine 131, no. 12 (1999): 970-972;
23. M. Hingorani, T. Wong, and G. Vafidis, "Patients' and Doctors' Attitudes to Amount of Information Given after Unintended Injury during Treatment: Cross Sectional, Questionnaire Survey," British Medical Journal 318, no. 7184 (1999): 640-641;
24. and A.W. Wu et al., "Do House Officers Learn from Their Mistakes?" Journal of the American Medical Association 264, no. 4 (1991): 2089-2094.
25. T.A. Brennan, "The Institute of Medicine Report on Medical Errors - Could It Do Harm?" New England Journal of Medicine 342, no. 15 (2000): 1123-1125;
26. and D.M. Studdert and T.A. Brennan, "No-Fault Compensation for Medical Injuries: The Prospect for Error Prevention," Journal of the American Medical Association 286, no. 2 (2001): 217-228.
27. G. Porto, "Disclosure of Medical Error: Facts and Fallacies," Journal of Healthcare Risk Management 21, no. 4 (2001): 67-76;
28. C. Vincent, Clinical Risk Management: Enhancing Patient Safety (London: BMJ Books, 2001), 476-478;
29. and M.B. Kapp, "Legal Anxieties and Medical Mistakes," Journal of General Internal Medicine 12, no. 12 (1997): 787-788.
30. S. Kraman and G. Hamm, "Risk Management: Extreme Honesty May Be the Best Policy," Annals of Internal Medicine 31, no. 12 (1999): 963-967.
31. J. Tieman, "Enforcing a New Openness," Modern Healthcare 31, no. 26 (2001): 4-5;
32. and J. Conway, "Creating a Culture of Safety: Challenge Your Mental Models 'Cause It Ain't Necessarily So!" (Speech at American Society for Healthcare Risk Management conference, Boston, 29 October 2001).
33. D. Pietro et al., "Detecting and Reporting Medical Errors: Why the Dilemma?" British Medical Journal 320, no. 7237 (2000): 794-796.
34. A. Witman, D. Park, and S. Hardin, "How Do Patients Want Physicians to Handle Mistakes? A Survey of Internal Medicine Patients in an Academic Setting," Archives of Internal Medicine 156, no. 22 (1996): 2565-2669;
35. W. Levinson, "Physician-Patient Communication: The Relationship with Malpractice Claims among Primary Care Physicians and Surgeons," Journal of the American Medical Association 277, no. 7 (1997): 553-559;
36. and G.B. Hickson et al., "Factors That Prompted Families to File Medical Malpractice Claims following Perinatal Injuries," Journal of the American Medical Association 267, no. 10 (1992): 1359-1363.
37. Studdert and Brennan, "No-Fault Compensation for Medical Injuries."
38. See, for example, U.S. House of Representatives, "Help Efficient, Accessible, Low Cost, Timely Health Care (HEALTH) Act of 2002," H.R. 4600,107th Cong., 2d sess. (25 April 2002); and "Healthcare Services Malpractice Act," H.B. 1802, 186th Leg., Reg. Sess. (Pa. 2002), Public Law 154, No. 13, Sec. 5104.
39. M.L. Millenson, "Pushing the Profession: How the News Media Turned Patient Safety into a Priority," Quality and Safety in Health Care 11, no. 1 (2002): 57-63.
40. For example, if low frequency of disclosure (for instance, as a proportion of all harms) were correlated with low quality, the gap we identified between disclosures and actual adverse events may be even greater, given some evidence of relatively low quality of care in for-profit hospitals. See E.J. Thomas et al., "Hospital Ownership and Preventable Adverse Events," Journal of General Internal Medicine 15, no. 4 (2000): 211-219;
41. P.J. Devereaux et al., "A Systematic Review and Meta-Analysis of Studies Comparing Mortality Rates of Private For-Profit and Private Not-for-Profit Hospitals," Canadian Medical Association Journal 166, no. 11 (2002): 1399-1406;
42. and Y.C. Shen, "The Effect of Hospital Ownership Choice on Patient Outcomes after Treatment for Acute Myocardial Infarction," Journal of Health Economics 21, no. 5 (2002): 901-922.
43. Amori, "President's Message";
44. American Society for Healthcare Risk Management, ASHRM conference agenda, 2001;
45. and M. Ott, "Key Considerations on Drafting a Policy on Disclosure of Unanticipated Outcomes," Journal of Healthcare Risk Management 21, no. 4 (2001): 27-31.
46. Porto, "The Risk Manager's Role";
47. and D. Finkelstein et al., "When a Physician Harms a Patient by Medical Error: Ethical, Legal, and Risk Management Considerations," Journal of Clinical Ethics 8, no. 4 (1997): 330-335.
48. E.J. Emanuel and L.L. Gorman, "Four Models of the Physician-Patient Relationship," Journal of the American Medical Association 267, no. 16 (1992): 2221-2226.
49. T. Gorman, "Physicians Fold under Malpractice Fee Burden," Los Angeles Times, 4 March 2002;
50. K. Hundley, "Prognosis for Trouble," St. Petersburg Times, 11 March 2002;
51. M. Freedman, "The Tort Mess," Forbes, 13 May 2002;
52. and J.B. Treaster, "New York Doctors Facing Big Jump in Insurance Rates," New York Times, 22 March 2002.