Pediatricians willing to disclose medical errors but consider current reporting systems inadequate

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:

• 97 percent believed that serious errors should be reported to the hospital, 90 percent that minor errors should be reported and 82 percent that near misses should be reported

• Most (92 percent) had used a formal error reporting mechanisms, such as an incident report (65 percent)

• Many (74 percent) also used informal error reporting mechanisms, such as telling their supervisors (47 percent) or a senior physician (38 percent), and 72 percent had discussed errors with colleagues

• Only 39 percent thought that current formal error reporting systems were adequate

• 99 percent thought serious errors should be disclosed to patients' families, 90 percent that minor errors should be disclosed and 39 percent that near misses should be disclosed

• 36 percent had ever disclosed a serious error to a patient's family and 52 percent had disclosed a minor error in the past 12 months

• 96 percent of residents and 86 percent of attending physicians believed that disclosing serious errors would be difficult

• 69 percent of residents and 56 percent of attending physicians wanted disclosure training

"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.