Most pediatricians support both reporting medical errors to hospitals and disclosing them to patients' families, but believe formal error reporting systems are inadequate and struggle with personal disclosure, according to survey results published in the February issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
Physicians are encouraged to openly communicate about errors to improve patient safety, according to background information in the article. However, many errors remain unknown to both the medical institution and the patient involved. This could be due to the medical culture of autonomy and individual accountability, the threat of legal action or fear of damage to the physician's professional reputation. Pediatricians face additional challenges in error disclosure because a third party, the patient's parents, are involved.
Jane Garbutt, M.B.Ch.B., Washington University School of Medicine, and colleagues surveyed 439 pediatric attending physicians and 118 pediatric residents in St. Louis and Seattle. The survey, distributed by mail and on the Internet between July 2003 and March 2004, contained 68 questions examining the physicians' attitudes about and experiences with error communication. Types of errors included serious errors, which cause permanent or life-threatening injury; minor errors, which cause harm that is temporary and not life-threatening; and near misses, errors that could have caused harm but did not because of chance or intervention.
Seventy-six percent of the responding physicians agreed that medical errors were one of the most serious problems in health care, and most reported that they had been involved in at least one error: 39 percent a serious error, 72 percent a minor error and 61 percent a near miss. Among the physicians:
"While pediatricians endorse reporting errors to the hospital and disclosing errors to patients' families, system changes are required to facilitate these communications," the authors write. "The hospital must facilitate the reporting of errors and near misses by pediatricians so that effective, safer systems of care can be developed and implemented. In additional, open and honest discussions following pediatric errors must occur to maintain and improve patient trust. Such open communications about errors are likely to benefit current and future pediatric patients, their families, pediatricians and the hospital."
(Arch Pediatr Adolesc Med. 2007;161:179-185. Available pre-embargo to the media at www.jamamedia.org .)
Editor's Note: Funding for this study was provided by grants from the Agency for Healthcare Research and Quality; St. Louis Children's Hospital; and Seattle Children's Hospital and Regional Medical Center. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Archives of Pediatrics and Adolescent Medicine