BMJ: Explaining and apologizing to patients after errors does not increase lawsuits, finds study

Explaining and apologizing to patients after errors does not increase lawsuits, finds study
Published 03 October 2017 Cite this as: BMJ 2017;359:j4536

Explaining and apologizing to patients after a medical error has resulted in injury does not result in an increase in lawsuits, a large US study has reported.1

In the face of growing numbers of lawsuits, many US hospitals have introduced “communication and resolution” programs over the past few years. In these programs hospitals communicate with patients when adverse events have occurred, investigate and explain what happened, apologize where appropriate, and offer compensation where failure to follow standard procedures led to significant harm.

The study analyzed the documentation and outcomes for all 989 cases referred to these programs in two academic medical centers and four community hospitals in Massachusetts, from 2013 to 2015. Most of the events (929, 88.9%) were reported by hospital staff, while 60 cases (6.1%) entered the programs because a patient made a claim against the hospital providing their care.

Results, reported in Health Affairs, showed that very few cases escalated to legal action. Only 5.1% (47 of 929 events) reported to the communication and resolution programs by hospital staff led to claims or lawsuits. And among all of the adverse events considered, including those referred to the programs because patients had made a claim, 4.0% (40) were settled with compensation offered by the hospitals without lawsuits, and this was generally modest (median $75 000 (£56 043; €53 441)).

“Our findings suggest that communication and resolution programs will not lead to higher liability costs when hospitals adhere to their commitment to offer compensation proactively,” said the study authors, led by Michelle Mello, professor of health research and policy and law at Stanford University.
Adherence to the programs was generally good. An initial communication with the patient or family discussing the harm event was documented for 81.8% (760 of 929) of the events referred by hospital staff. And feedback to the patient on the investigation findings was documented in 60.7% (573 of 944) of the events that were investigated.

The low percentage of events that led to litigation should reassure hospitals worried about the risks of being honest with patients, the authors said. They said that explaining why adverse events occurred may have defused patients’ anger in many cases.

Further results showed that the standard of care had been met in nearly three quarters of cases (73.7%, 675 of 916 cases) investigated, and had been violated in just over one in four cases (26.3%, 241 of 916 cases). Overall, the hospitals determined that 9.0% of the events that involved significant harm were caused by substandard care.

The study was funded by Baystate Health Insurance Company, Blue Cross Shield of Massachusetts, CRICO RMF, Coverys, Harvard Pilgrim Health Care, Massachusetts Medical Society, and Tufts Health plan.
None of the sponsors were involved in the analysis or reporting of data.

References
1. ↵Mello MM, Kachalia A, Roche S, et al. Outcomes in two Massachusetts hospital systems give reason for optimism about communication-and-resolution programs. Health Aff2017. doi:10.1377/hlthaff.2017.0320.

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