Press Room: Press Releases

EMBARGOED FOR RELEASE: 12:01 a.m. (CT), Monday, May 1, 2006

Critical Care’s Efforts to Disclose Medical Errors and Adverse Events

Disclosure may not increase lawsuits

(DES PLAINES, Ill. April 27, 2006) — The benefits of disclosing medical errors and adverse events are greater than the potential drawbacks and disclosure corresponds with the ethical responsibilities of physicians, according to an article in the May issue of Critical Care Medicine, the journal of the Society of Critical Care Medicine.

“My co-investigators and I expect that disclosure will become the standard in the near future,” says lead author Dennis Boyle, M.D., assistant professor of medicine at University of Colorado Health Sciences Center and assistant professor of rheumatology at Denver Health Medical Center.  “At the University of Colorado Health Sciences Center, medical students learn the skills that help with the disclosure of errors and adverse events.” 

In 1999, the Institute of Medicine reported that as many as 98,000 people die annually in the United States as a result of medical errors, making errors the eighth leading cause of death.  In a critical care setting, the complexity of illness and trauma exponentially increases the risk of error and subsequent adverse events.  Dr. Boyle says that many medical practitioners are currently unaccustomed to revealing medical errors and adverse events to patients and families.

In the article, the researchers review the issues surrounding disclosure of errors in care and adverse events that harmed critical care patients and then provide a framework for implementing a disclosure.

The researchers found that failure to disclose errors and adverse events in critical care is an important and common problem.  Although the authors believe not all errors or adverse events require disclosure, they discuss ethical, financial, legal, and personal benefits to disclosing errors.  They conclude that the use of a standard framework for doing so will facilitate developing a disclosure process. 

“The process of disclosing errors requires courage, composure, communication skills and a belief that the patient is entitled to know the truth,” comments Dr. Boyle.  “It typically takes a team of people and a series of conversations to complete all the steps necessary to understand, disclose, correct and arrange for appropriate help or compensation for the injured party.”

The article includes a variety of pros and cons for disclosure.  Dr. Boyle and colleagues found that open disclosure leads to more rapid diagnosis and additional treatment while at the same time preventing additional complications.  Disclosure can help patients receive injury compensation and, on a more personal level, disclosure may diminish concerns about other unanticipated outcomes and may help re-establish trust, strengthening the physician-patient relationship.  Benefits to physicians include reduced risk of malpractice litigation since patients and families feel that the situation has been handled honorably.  Physicians may also feel less guilt and receive absolution from patients and their families.  Disclosure also encourages improvements in medical practice.

The dangers of disclosure include patient rejection of physicians, malpractice lawsuits, a loss of referrals, hospital admitting privileges, and licensure.

“Making a mistake and getting sued are two different things,” Dr. Boyle comments. “People sue over both medical errors and textbook-perfect care.  Lawsuits may be based more on anger and frustration than actual care.”

“There is a clear need for ICU physicians to improve their willingness and their ability to disclose errors of care in the ICU, and to develop effective guidelines for managing these situations in the best interest of all parties,” concludes Dr. Boyle.  “Clarifying the causes of a disappointing outcome, acknowledging individual and system failures, and appreciating the impact on the patient are all difficult and humbling obligations.  If the investigation discovers a medical or systems error, physicians, other health care providers and risk management should develop a coordinated response to the patient and family.  All of these steps are necessary to preserve the integrity of the doctor-patient-facility relationship, and all are, in part, dependent on hospital administrators’ creating a culture in which patient safety is a primary objective, and disclosure of errors is the expected course of action.”

Editorial: Acknowledging Our Mistakes

In an accompanying editorial in the May issue of Critical Care Medicine, John M. Luce, M.D., professor of medicine and anesthesia at the University of California, San Francisco and chief medical officer at San Francisco General Hospital, expands on the research of Dr. Boyle and his coauthors.  Dr. Luce agrees that the Boyle article offers a reasonable and practical approach to the disclosure of medical errors in the ICU.

“I believe that hospitals can best increase disclosure by developing voluntary, non-punitive programs through which physicians, including house officers, are encouraged to report medical errors and adverse events,” concludes Dr. Luce.  “Root cause analysis in which physicians participate should be performed to identify systems problems responsible for the errors and events, and disclosure should be asked for if harm meeting the requirements of Boyle and co-authors has occurred.”

“The study is important because disclosure is the direction in which critical care is moving,” said Joseph E. Parrillo, M.D., editor-in-chief of Critical Care Medicine.  “We need to do a better job of disclosing errors and adverse events.”

Critical Care Medicine is the official journal of the Society of Critical Care Medicine. It is the premier peer-reviewed, scientific publication in critical care medicine. Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research, and advances in equipment and techniques.

The Society of Critical Care Medicine is the leading professional organization dedicated to ensuring excellence and consistency in the practice of critical care medicine. With more than 13,000 members worldwide, the Society is the only professional organization devoted exclusively to the advancement of multiprofessional intensive care through excellence in patient care, professional education, public education, research and advocacy. Members of the Society include intensivists, critical care nurses, critical care pharmacists, clinical pharmacologists, respiratory care practitioners and other professionals with an interest in critical care, including physician assistants, social workers and dietitians.

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