Disclosure of "Nonharmful" Medical Errors and Other Events Duty to Disclose

Department of Surgery, School of Medicine, The Johns Hopkins University, Harvey Room 611, 600 N Wolfe St, Baltimore, MD 21287, USA.
Archives of surgery (Chicago, Ill.: 1960) (Impact Factor: 4.93). 03/2012; 147(3):282-6. DOI: 10.1001/archsurg.2011.1005
Source: PubMed


An estimated 98 000 patients die in the United States each year because of medical errors. One million or more total medical errors are estimated to occur annually, which is far greater than the actual number of reported "harmful" mistakes. Although it is generally agreed that harmful errors must be disclosed to patients, when the error is deemed to have not resulted in a harmful event, physicians are less inclined to disclose it. Little has been written about the handling of near misses or "nonharmful" errors, and the issues related to disclosure of such events have rarely been discussed in medicine, although they are routinely addressed within the aviation industry. Herein, we elucidate the arguments for reporting nonharmful medical errors to patients and to reporting systems. A definition of what constitutes harm is explored, as well as the ethical issues underpinning disclosure of nonharmful errors. In addition, systematic institutional implications of reporting nonharmful errors are highlighted. Full disclosure of nonharmful errors is advocated, and recommendations on how to discuss errors with patients are provided. An argument that full error disclosure may improve future patient care is also outlined.

Download full-text


Available from: Albert W Wu, Mar 11, 2015
  • [Show abstract] [Hide abstract]
    ABSTRACT: Review question/objective The objective of this systematic review is to synthesise the best available qualitative evidence available exploring health professionals’ perceptions and experiences of open disclosure of medical errors to patients. Consequently the question to be addressed is: What are the perceptions and experiences of health professionals regarding open disclosure of medical errors to patients? More specifically to explore where possible What are the perceptions and experiences of barriers to open disclosure of medical errors to patients by health professionals? What are the perceptions and experiences of facilitators of open disclosure of medical errors to patients by health professionals?
    No preview · Article · Jan 2012 · JBI Database of Systematic Reviews and Implementation Reports
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE:: To compare the distribution, causes, and consequences of medication errors in the ICU with those in non-ICU settings. DESIGN:: A cross-sectional study of all hospital ICU and non-ICU medication errors reported to the MEDMARX system between 1999 and 2005. Adjusted odds ratios are presented. SETTING:: Hospitals participating in the MEDMARX reporting system. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: MEDMARX is an anonymous, self-reported, confidential, deidentified, internet-accessible medication error reporting program that allows hospitals to report, track, and share medication error data. There were 839,553 errors reported from 537 hospitals. ICUs accounted for 55,767 (6.6%) errors, of which 2,045 (3.7%) were considered harmful. Non-ICUs accounted for 783,800 (93.4%) errors, of which 14,471 (1.9%) were harmful. Errors most often originated in the administration phase (ICU 44% vs. non-ICU 33%; odds ratio 1.63 [1.43-1.86]). The most common error type was omission (ICU 26% vs. non-ICU 28%; odds ratio 1.00 [0.91-1.10]). Among harmful errors, dispensing devices (ICU 14% vs. non-ICU 7.1%; odds ratio 2.09 [1.69-2.59]) and calculation mistakes (ICU 9.8% vs. non-ICU 5.3%; odds ratio 1.82 [1.48-2.24]) were more commonly identified to be the cause in the ICU compared to the non-ICU setting. ICU errors were more likely to be associated with any harm (odds ratio 1.89 [1.62-2.17]), permanent harm (odds ratio 2.45 [1.17-5.13]), harm requiring life-sustaining intervention (odds ratio 2.91 [1.86-4.56]), or death (odds ratio 2.48 [1.18-5.19]). When an error did occur, patients and their caregivers were rarely informed (ICU 1.5% vs. non-ICU 2.1%; odds ratio 0.63 [0.48-0.84]) by the time of reporting. CONCLUSIONS:: More harmful errors are reported in ICU than non-ICU settings. Medication errors occur frequently in the administration phase in the ICU. When errors occur, patients and their caregivers are rarely informed. Consideration should be given to developing additional safeguards against ICU errors, particularly during drug administration, and eliminating barriers to error disclosures.
    No preview · Article · Dec 2012 · Critical care medicine
  • [Show abstract] [Hide abstract]
    ABSTRACT: Using the Institute of Medicine framework that outlines the domains of quality, this article considers four key aspects of health care delivery which have the potential to significantly affect the quality of health care within the pediatric intensive care unit. The discussion covers: performance improvement and how existing methods for reporting, review, and analysis of medical error relate to patient care; team composition and workflow; and the impact of information technologies on clinical practice. Also considered is how protocol-driven and standardized practice affects both patients and the fiscal interests of the health care system.
    No preview · Article · Apr 2013 · Critical care clinics
Show more