National guidelines recommend that surgeons and other health care providers fully disclose adverse events, including medical errors, to patients and their family members.
But a new study finds that while surgeons at three Veterans Affairs (VA) hospitals routinely disclosed adverse events within 24 hours and expressed regret for what happened, only about half discussed the events in detail or apologized to patients. Just 55 percent of the surgeons reported discussing whether the event was preventable—and only one-third discussed steps for preventing further harm.
Further, surgeons who were less likely to follow disclosure recommendations were more likely to be “negatively affected” by the experience. Also, those who perceived an adverse event to be extremely or very serious, and those who had difficulty communicating with patients and families, were more likely to be negatively affected.
“Many of the surgeons in our study indicated that they had difficulty with some recommended elements of disclosure, including discussing the preventability of the event and efforts to prevent recurrences,” says lead author A. Rani Elwy, associate professor of health law, policy, and management at Boston University. “It’s important to know that not all surgeons are disclosing this information, even though patients have indicated they would prefer to know.”
Also, surgeons who don’t disclose detailed information report being more negatively impacted by the adverse events, she says. “Recognizing this association between disclosure and surgeons’ well-being is important. It suggests that open disclosure policies have many benefits, for surgeons as well as patients.”
Published in JAMA Surgery, the study was based on 62 surveys completed by surgeons at VA facilities. The doctors, in various specialties, were asked to identify a recent case involving an unplanned return to the operating room, or an unplanned procedural intervention, within 30 days after surgery.
Most of the surgeons (97 percent) reported disclosing the adverse event to the patient and family members within 24 hours, and most (87 percent) expressed regret for what happened.
But the numbers dropped when it came to surgeons who apologized to patients or discussed whether the event was preventable. The topic of prevention may be difficult for these doctors to discuss, or that the physicians may worry that such discussions “suggest blame” for the event.
In gauging surgeons’ experiences with disclosure, the study found that those who reported “difficult conversations” with patients and families were more negatively affected. The finding suggests that “greater training to support surgeons may be needed,” including how to discuss challenging issues such as preventability.
Noting that the study was based in the VA, Elwy and colleagues call for more research examining disclosures in other health care systems. Such research could help to shape future quality-improvement efforts that encourage open disclosure, while also “ensuring a healthy surgeon workforce.”
Other researchers from Boston University and from Harvard University, the University of Washington, Yale University, and several VA health care systems are coauthors of the study. which was funded by a grant from the Department of Veterans Affairs, Health Services Research, and Development Service.
Source: Boston University