1
|
Passini L, Le Bouedec S, Dassieu G, Reynaud A, Jung C, Keller ML, Lefebvre A, Katty T, Baleyte JM, Layese R, Audureau E, Caeymaex L. Error disclosure in neonatal intensive care: a multicentre, prospective, observational study. BMJ Qual Saf 2023; 32:589-599. [PMID: 36918264 DOI: 10.1136/bmjqs-2022-015247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 11/08/2022] [Indexed: 03/16/2023]
Abstract
IMPORTANCE Surveys based on hypothetical situations suggest that health-care providers agree that disclosure of errors and adverse events to patients and families is a professional obligation but do not always disclose them. Disclosure rates and reasons for the choice have not previously been studied. OBJECTIVE To measure the proportion of errors disclosed by neonatal intensive care unit (NICU) professionals to parents and identify motives for and barriers to disclosure. DESIGN Prospective, observational study nested in a randomised controlled trial (Study on Preventing Adverse Events in Neonates (SEPREVEN); ClinicalTrials.gov). Event disclosure was not intended to be related to the intervention tested. SETTING 10 NICUs in France with a 20-month follow-up, starting November 2015. PARTICIPANTS n=1019 patients with NICU stay ≥2 days with ≥1 error. EXPOSURE Characteristics of errors (type, severity, timing of discovery), patients and professionals, self-reported motives for disclosure and non-disclosure. MAIN OUTCOME AND MEASURES Rate of error disclosure reported anonymously and voluntarily by physicians and nurses; perceived parental reaction to disclosure. RESULTS Among 1822 errors concerning 1019 patients (mean gestational age: 30.8±4.5 weeks), 752 (41.3%) were disclosed. Independent risk factors for non-disclosure were nighttime discovery of error (OR 2.40; 95% CI 1.75 to 3.30), milder consequence (for moderate consequence: OR 1.85; 95% CI 0.89 to 3.86; no consequence: OR 6.49; 95% CI 2.99 to 14.11), a shorter interval between admission and error, error type and fewer beds. The most frequent reported reasons for non-disclosure were parental absence at its discovery and a perceived lack of serious consequence. CONCLUSION AND RELEVANCE In the particular context of the SEPREVEN randomised controlled trial of NICUs, staff did not disclose the majority of errors to parents, especially in the absence of moderate consequence for the infant. TRIAL REGISTRATION NUMBER NCT02598609.
Collapse
Affiliation(s)
- Loïc Passini
- Neonatal Intensive care Unit, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | | | - Gilles Dassieu
- Neonatal Intensive care Unit, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | | | - Camille Jung
- Clinical Research Center, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | - Marie-Laurence Keller
- Neonatal Intensive care Unit, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Aline Lefebvre
- Department of Child and Adolescent Psychiatry, APHP, Paris, France
- Human Genetics and Cognitive Functions, Institut Pasteur, UMR 3571 CNRS, University Paris Diderot, Paris, France
- Child and Adolescent Psychiatry Creteil, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | - Therese Katty
- Health Law Manager, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | - Jean-Marc Baleyte
- Child and Adolescent Psychiatry Creteil, Centre Hospitalier Intercommunal de Creteil, Creteil, France
- Faculty of Health, University Paris Est Creteil, Creteil, France
| | - Richard Layese
- INSERM IMRB, CEpiA Team, University Paris Est Creteil, Creteil, France, Créteil, France
- Unité de Recherche Clinique (URC), Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris APHP, Créteil, France
| | - Etienne Audureau
- INSERM IMRB, CEpiA Team, University Paris Est Creteil, Creteil, France, Créteil, France
- Unité de Recherche Clinique (URC), Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris APHP, Créteil, France
| | - Laurence Caeymaex
- Neonatal Intensive care Unit, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- Clinical Research Center, Centre Hospitalier Intercommunal de Creteil, Creteil, France
- Faculty of Health, University Paris Est Creteil, Creteil, France
| |
Collapse
|
2
|
Schinasi DA, Kolaitis IN, Nadel FM, An-Grogan Y, Burns R, Berman L, Quinn AM, Shaw KN. Using Immersive Simulation to Engage Pediatric Residents in Difficult Conversations and the Disclosure of Patient Safety Events. Cureus 2018; 10:e3095. [PMID: 30324048 PMCID: PMC6171778 DOI: 10.7759/cureus.3095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 08/03/2018] [Indexed: 11/05/2022] Open
Abstract
Background Full disclosure of patient safety events (PSE) is desired by patients and their families, is required by the Joint Commission and many state laws, and is vital to improving patient outcomes. A key barrier to consistent disclosure of patient safety events is a self-reported lack of proper training. Physicians must be trained to recognize when a PSE has occurred and effectively carry out disclosure, all while caring for a patient who is actively experiencing the consequences of an unintended outcome. Immersive simulation provides the opportunity to practice this complex skill. Objective To develop and evaluate a simulation-based workshop for pediatric residents on the disclosure of patient safety events. Methods A workshop in PSE disclosure was developed according to literature review, expert consultation, and feedback from hospital administration. The three-hour workshop included a simulated PSE with a subsequent standardized debriefing, interactive didactic session, and additional simulation-based hands-on practice in disclosure. Participants completed an anonymous survey at one-week and three-months post workshop, assessing workshop satisfaction, subsequent clinical experience, and perceived change to their practice. Results During the one-year study period, 27/31 (87.0%) second year residents completed the workshop. At the one-week follow-up, all study participants reported increased confidence and preparedness in their ability to lead the initial disclosure conversation. All study participants felt that the simulated scenarios were realistic and relevant to their current clinical duties and 33.3% (n=9) stated that they would like to repeat this workshop prior to completion of their training. At the three-month follow-up, 29.6% (N=8) of study participants reported involvement in the disclosure of a patient safety event since the workshop with all eight reporting feeling adequately prepared by the workshop for this experience. Study participants indicated that post training they were more likely to engage the attending physician, risk management and patient relations in the disclosure conversation (p <=0.05). The estimated cost of this simulation training for 27 residents was $6,993, not accounting for the 39 hours per clinician facilitator. Conclusions Immersive simulation is uniquely suited for teaching difficult conversation skills that are encountered during acute care, including the disclosure of patient safety events. While hands-on practice is critical, faculty and simulation resources required for continued implementation may not be sustainable long-term. Future training curricula should leverage creative and innovative adult-learning techniques to reach a wide range of members of the care team with less resource utilization.
Collapse
Affiliation(s)
- Dana A Schinasi
- Pediatrics, Ann & Robert H Lurie Children's Hospital of Chicago/Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Irini N Kolaitis
- Hospital Based Medicine, Northwestern University Feinberg School of Medicine/Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
| | - Frances M Nadel
- Pediatric Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Yuemi An-Grogan
- Pediatric Emergency Medicine, Ann & Robert H Lurie Children's Hospital of Chicago/Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Rebekah Burns
- Pediatrics, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, USA
| | - Leah Berman
- Pediatric Emergency Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, USA
| | - Annie M Quinn
- Pediatric Emergency Medicine, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, USA
| | - Kathy N Shaw
- Pediatric Emergency Medicine, Perelman School of Medicine/university of Pennsylvania, Philadelphia, USA
| |
Collapse
|
3
|
Ock M, Lim SY, Jo MW, Lee SI. Frequency, Expected Effects, Obstacles, and Facilitators of Disclosure of Patient Safety Incidents: A Systematic Review. J Prev Med Public Health 2017; 50:68-82. [PMID: 28372351 PMCID: PMC5398338 DOI: 10.3961/jpmph.16.105] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 01/17/2017] [Indexed: 11/30/2022] Open
Abstract
Objectives We performed a systematic review to assess and aggregate the available evidence on the frequency, expected effects, obstacles, and facilitators of disclosure of patient safety incidents (DPSI). Methods We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for this systematic review and searched PubMed, Scopus, and the Cochrane Library for English articles published between 1990 and 2014. Two authors independently conducted the title screening and abstract review. Ninety-nine articles were selected for full-text reviews. One author extracted the data and another verified them. Results There was considerable variation in the reported frequency of DPSI among medical professionals. The main expected effects of DPSI were decreased intention of the general public to file medical lawsuits and punish medical professionals, increased credibility of medical professionals, increased intention of patients to revisit and recommend physicians or hospitals, higher ratings of quality of care, and alleviation of feelings of guilt among medical professionals. The obstacles to DPSI were fear of medical lawsuits and punishment, fear of a damaged professional reputation among colleagues and patients, diminished patient trust, the complexity of the situation, and the absence of a patient safety culture. However, the factors facilitating DPSI included the creation of a safe environment for reporting patient safety incidents, as well as guidelines and education for DPSI. Conclusions The reported frequency of the experience of the general public with DPSI was somewhat lower than the reported frequency of DPSI among medical professionals. Although we identified various expected effects of DPSI, more empirical evidence from real cases is required.
Collapse
Affiliation(s)
- Minsu Ock
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - So Yun Lim
- Department of Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Min-Woo Jo
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Il Lee
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
4
|
Koller D, Rummens A, Le Pouesard M, Espin S, Friedman J, Coffey M, Kenneally N. Patient disclosure of medical errors in paediatrics: A systematic literature review. Paediatr Child Health 2016; 21:e32-8. [PMID: 27429578 DOI: 10.1093/pch/21.4.e32] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Medical errors are common within paediatrics; however, little research has examined the process of disclosing medical errors in paediatric settings. The present systematic review of current research and policy initiatives examined evidence regarding the disclosure of medical errors involving paediatric patients. Peer-reviewed research from a range of scientific journals from the past 10 years is presented, and an overview of Canadian and international policies regarding disclosure in paediatric settings are provided. The purpose of the present review was to scope the existing literature and policy, and to synthesize findings into an integrated and accessible report. Future research priorities and policy implications are then identified.
Collapse
|