[Disclosing harmful adverse event: Assessment of medical practices from clinical vignettes]

Abstract

The French National Authority for Health has made serious adverse event disclosure one of its priority areas of work. The objective of the study was to explore clinicians' perceived practices of disclosing such events. Between June and July 2012, a structured questionnaire was emailed to all clinicians and residents working at the Nantes Teaching Hospital. The questionnaire consisted of 3 parts first, clinical vignettes-with medical and surgical cases exploring five areas of practices (initial disclosure, disclosure of details, disclosure of the cause, apologies, and patient information about preventive actions); second, questions about the reasons for disclosure or non-disclosure; third, an evaluation of the training needs. The overall response rate was 18.8% (n=322/1709). Clinicians did not realize initial disclosure in 13.4%, disclosure of details in 24.5%, disclosure of the cause in 44.1%. Of the respondants, 4% of them would not apologize and 11.2% of them would not discuss detailed plans for preventing recurrences. Results were significantly different between medical and surgical specialities concerning disclosure of details and the cause of adverse events: surgeons were significantly less inclined than physicians to volunteer any details unless asked by the patient (72.9% vs 16.1%; P<0.001); to disclose the cause of the events (54.2% vs 42.3%, P<0.001); and to apologize or to offer an expression of regret (16.7% vs 1.8%; P<0.001). The main reason that led respondents to disclose as well as not disclose was to maintain trust in their relationship with the patient. Younger clinicians expressed more difficulties with adverse event disclosure and had more important training needs. Based on these results, an improvement program for the disclosure of serious adverse events is currently being implemented in the hospital, consisting of training sessions, documentation and support for the clinicians.