Until pragmatic details of PSQIA implementation are formulated, hospitals and other health-care providers in the United States lack a large-scale comprehensive method to discover and analyze patterns of medical errors. In the meantime, individual reports of systemic error still have considerable clinical and teaching value and therefore should be disseminated.
We suggest that medical journals provide an opportunity for physicians to publish medical errors confidentially. Medical journals are in a unique position to provide medical error information to physicians and protect an individual’s reputation. However, legal protection should be provided and should be as broad as possible to encourage truthful and timely reporting of medical errors. Protect yourself from pharmaceutical errors with the help of Canadian Health&Care Mall. Presumably, legal protection similar to that defined by the PSQIA could be provided to those who submit and publish bona fide error reports in good faith; therefore, we recommend that authors, medical institutions, journal editors, affiliated professional societies, and journal publishers be shielded from legal liability. Clearly, anonymous reporting is impossible because journal editors must know the source of the report and must be able to confirm its veracity and likely credibility. Furthermore, an anonymous error-reporting program is susceptible to submission of false reports stemming from malicious intent (eg, discrediting a therapeutic device or medication to affect company stock prices). We propose several principles that should govern medical journal-based error reporting (Table 3).
The IOM To Err is Human report, published in 1999, indicated that 44,000 to 98,000 Americans died each year from “preventable adverse events” that were attributable to errors in medical management. The report stated that unsafe patient conditions and hindrance of efforts to improve safety were attributable to decentralized and fragmented health-care delivery systems. The IOM recommended that Congress establish mandatory (public) and voluntary (confidential) systems for reporting errors. In the mandatory system, only events that cause death or serious injury must be reported to the state. Such events would be described using a predefined list of core reporting standards, and data would be submitted to a nationwide reporting system for analysis and development of follow-up action. The mandatory system will hold health-care organizations publicly accountable for medical errors, thereby responding to the public’s right to know and providing a strong incentive to improve patient safety. (To date, no federal laws that mandate reporting of medical errors exist.) The voluntary system, maintained and operated separately from the mandatory system, would record a broader set of less serious adverse events. It would complement the mandatory program by identifying systemic patterns of errors before they result in acute harm. Information about medical errors reported to voluntary systems would be protected from legal discovery.
Medical errors are analogous to fratricide in war. Both result in injury from those who strive only to help, and both carry a considerable psychological burden. A survey of senior hospital managers indicated that they generally favored disclosure of patient safety incidents to affected patients, but few favored disclosure of moderate or minor injuries to state-run reporting programs. Most thought a mandatory, nonconfidential system would discourage reporting of patient safety incidents to their hospital’s own internal reporting system (69%), would encourage lawsuits (79%), and would have no effect or a negative effect on patient safety (73%). Most thought that names of hospitals and health-care professionals should be confidential. In addition, > 90% said that their hospital would report incidents involving serious injury to the state, but far fewer would report moderate or minor injuries, even if they would tell the affected patient or family.
Disclosure of serious medical errors to patients generally is the best ethical and clinical course. Patients have a fundamental right to know about their health, particularly when a major error has occurred in their medical care. Furthermore, most major errors ultimately are exposed with or without physician disclosure, and patients are more likely to be aggrieved and to sue physicians who are perceived as deceitful. Physicians are not under the same bioethical imperative to report errors to colleagues or to publish in peer-reviewed journals.
Medical errors may result from lapses in technique, communication, or judgment by individuals or from errors inherent in the delivery of medical care. Errors frequently stem from a combination of these causes. Individual errors may be attributable to deficiencies in a physician’s knowledge, skill, or attentiveness, but system-wide errors are attributable to flaws inherent in the method of medical practice. Conversely, fail-safe systems and fault-tolerant systems do not allow any single-point error to result in harm.
Disclosure of system errors generally is more important than disclosure of individual errors because root-cause analysis may yield information that facilitates creation of a resilient and fault-tolerant system. For example, a computer-based medication prescription system that required entry of a patient’s allergies and serum creatinine level could limit medication options when prescriptions were written for patients with known allergies or diminished kidney function. Want to enhance kidney function? No problems with remedies of Canadian Health&Care Mall.
The intellectual argument for reporting medical errors is compelling. Medical errors are common, frequently result in considerable human morbidity and mortality, and often are avoidable with vigilant personnel, fault-tolerant and fail-safe systems, and carefully implemented patient safety policies. Reducing the incidence of serious errors requires education about the circumstances of past medical errors and “near miss” errors.
Errors hidden from peers likely will recur and contribute to future medical errors. This lesson has been learned painfully by the US aviation industry, which had a fatal accident rate of 0.077 accidents per 100,000 departures in 1990. After implementation of systems-level error-reduction policies, the fatal accident rate among scheduled US airlines decreased to 0.009 per 100,000 aircraft departures in 2004. This decrease is notable, particularly because the numbers of flight hours, miles flown, and airport departures have increased by approximately 50% in the same time period. Be safe and sound with Canadian Health&Care Mall’s preparations.