How to disclose errors by another provider

Disclosing a medical error is never easy, but it can become especially complicated when you need to tell the patient that a previous provider was in the wrong. This delicate situation often requires communication with the other provider before you tell the patient anything.

Once you have identified that an error occurred with another provider, or you suspect so, there should be no question about following up, says John C. Metcalfe, JD, FASHRM, vice president of risk management services with Memorialcare Health System in Fountain Valley, CA. It is unacceptable to simply ignore the situation and make no effort to inform the patient, he says.

However, in many situations, it is important that you not simply tell the patient as soon as you suspect there has been an error, he says. The second provider should contact the first and discuss the concerns, he says. "We contact the other hospital and make a determination in collaboration with that hospital about the disclosure," Metcalfe says. "We give the other hospital the opportunity to follow their own procedures for disclosure, because they might not have known about the error or the consequences of the error."

That collaboration might not always be possible, however. If a patient's X-ray in the ED reveals a retained sponge or needle from surgery at another facility, for instance, Metcalfe says there would be no time for collaborating because the patient would need immediate surgery. In such a case, Metcalfe's hospital would inform the patient right away and then alert the other provider about the finding.

Even determining the provider that committed the error can be difficult, Metcalfe says. If the patient had undergone a series of surgeries, for instance, it might not be clear who left a sponge behind. "We've had cases in the past where the patient indicated they had undergone a surgery fairly recently, and the easy assumption is that's where the error occurred," Metcalfe says. "Then we found out that the error actually occurred up the road a bit more, two or three surgeries back."

When the provider at fault is not clear, Metcalfe's hospital tries to contact all the providers that might be responsible to alert them and let them figure out the answer. But he says the hospital ultimately is not obligated to determine which other provider committed the error and sometimes must simply inform the patient and let him or her pursue the matter further.

Each case must evaluated individually, says Vivian Barker Miller, CPHQ, LHRM, CPHRM, FASHRM, senior risk management specialist with American Society for Healthcare Risk Management (ASHRM). There is no single correct way to address disclosing another provider's error, she says. "The goal must be to do the right thing for the patient, the family, and also the provider," she says. "Don't forget that this will be a significant issue for the provider. They are going to feel awful about this error and the consequences."

Although swift disclosure is necessary in some cases, providers usually should take a step back and carefully consider the situation before informing the patient that another provider erred, says Matson Sewell, MS, MPH, CPHRM, principal with Matson Sewell Healthcare Consulting in Sacramento, CA. Sewell has held multiple risk management positions with healthcare providers and was chair of an ASHRM task force on disclosure after adverse outcomes.

Providers should be cautious in declaring that another hospital erred because it did not treat the patient as they would have, Sewell says.

First determine if the other hospital's treatment falls into an acceptable range of treatment, Sewell advises. "Are we assuming that if they didn't do it exactly the way we would have done it, that it's an error?" she says. "Sometimes it's absolutely clear cut that they took the wrong approach, but I've often seen people assume it was a wrong approach when it really just wasn't the way they would have done it."

Sources

• Vivian Barker Miller, CPHQ, LHRM, CPHRM, FASHRM, Senior Risk Management Specialist, American Society for Healthcare Risk Management, Chicago. Telephone: (410) 507-5326. E-mail: mikeandvivian@verizon.net.

• John C. Metcalfe, JD, FASHRM, Vice President, Risk Management Services, Memorialcare Health System, Fountain Valley, CA. Telephone: (562) 933-2000. E-mail: jmetcalfe@memorialcare.org.

• Matson Sewell, MS, MPH, CPHRM, Principal, Matson Sewell Healthcare Consulting, Sacramento, CA. Telephone: (650) 815-5573. E-mail: matson@matsonsewell.com.