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Since July 1, 2001, U.S. hospitals have been required by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) to disclose to patients errors that harm them during the course of treatment. About 70 percent of hospitals increased the number of medical error disclosures in the past 2 years, according to a survey of hospital risk managers.
More than half of those surveyed said they would always disclose a death or serious injury. However, when presented with actual clinical scenarios, hospital risk managers were much less likely to disclose preventable harms than similarly severe nonpreventable harms. Also, hospitals that had major concerns about malpractice implications were twice as likely as other hospitals to be reluctant to disclose preventable harms, according to a study supported in part by the Agency for Healthcare Research and Quality (K02 HS11285).
David M. Studdert, Sc.D., of the Harvard School of Public Health, and his colleagues surveyed risk managers from a nationally representative sample of hospitals on how and what their hospitals were disclosing to patients 6 months after the JCAHO standards took effect. Over half (54 percent) of hospitals routinely told patients or their families when a patient had been harmed by care. Another 44 percent said such disclosures occurred some of the time, leaving 5 hospitals that did not disclose harm.
About 65 percent of hospitals always disclosed death or serious injury; a smaller proportion always disclosed serious, short-term harms. The most common elements of hospital disclosure were explanation, investigation of incident, apology, and acknowledgment of harm. However, relatively few hospitals declared responsibility for the harm. Half of the hospitals reported fewer than 5 disclosures per 10,000 annual admissions, considerably fewer than would be expected from general estimates (290 to 370 potential disclosable harms per 10,000 admissions).
See "Hospital disclosure practices: Results of a national survey," by Rae M. Lamb, Dr. Studdert, Richard M.J. Bohmer, and others, in the March 2003 Health Affairs 22(2), pp. 73-83.
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