Transparency in Adverse Event Reporting Pleases Patients

Hospitalized patients who suffer an adverse event may learn little about it from medical personnel, especially if the event is preventable, according to findings presented here at Hospital Medicine 2008, the Society of Hospital Medicine annual meeting. A survey of 603 patients who experienced 845 adverse events revealed that only 40% of those events were disclosed. The track record was even worse when the event was preventable — the disclosure rate of those events was only 28%, lead investigator Lenny Lopez, MD, from Massachusetts General Hospital, Boston, and colleagues reported.

The researchers conducted telephone interviews with adult medical and surgical acute-care patients who stayed in several Massachusetts hospitals between April 1 and October 1, 2003. Patients who said they had experienced an adverse event were asked whether anyone on the hospital staff had disclosed the event, explained why it happened, and offered to help the patient deal with the consequences of the event; the investigators also asked whether the event prolonged the patient's length of hospital stay or affected his or her perception of the quality of care. Finally, the researchers asked the patients whether they felt things could be done differently in the future.

Adverse events were more likely to be disclosed if they increased length of stay (odds ratio [OR], 1.82) or if the patient were male (OR, 1.53), whereas events deemed to be preventable were less likely to be disclosed (OR, 0.65). Patients who felt that they were able to protect themselves from adverse events were more likely to give high marks to quality of care (OR, 2.01), as were those who received an explanation of the event when it did occur (OR, 1.96). In contrast, patients who experienced significant discomfort were less likely to be pleased with their quality of care (OR, 0.62), as were those who felt things could be done differently in the future or who continued to experience repercussions from the adverse event (OR, 0.61 for both).

Clinicians may be reluctant to disclose adverse events to patients because of concerns over litigation, but these findings suggest that informed patients are more likely to be pleased with the quality of their care, the investigators said.

The low disclosure rate of preventable events was particularly unsettling, said Greg Maynard, MD, clinical professor of medicine at the University of California, San Diego. "With the technology we use, handoffs, complicated information systems, the powerful drugs and radiation, and the multiple interventions that many of these patients undergo, it's not surprising that some of these things are delivered incorrectly."

"[P]atients understand if the disclosure is done in good faith, and if the error was not the result of gross negligence," said Dr. Maynard, who was not involved in the study. However, "they get extraordinarily mad if the error is not disclosed and they find out about it accidentally."

The authors have disclosed no relevant financial relationships.

Hospital Medicine 2008: Abstract 47. Presented April 4, 2008.

J Hosp Med. 2008;3(suppl 1):26.

Reviewed By Dr. Ramaz MItaishvili

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