Iedema Rick, Allen Suellen, Sorensen Roslyn, Gallagher Thomas H
Centre for Health Communication, University of Technology, Sydney, Australia.
Jt Comm J Qual Patient Saf. 2011 Sep;37(9):409-17. doi: 10.1016/s1553-7250(11)37051-1.
Adverse-event incident disclosure is gaining international attention as being central to incident management, practice improvement, and public engagement, but those charged with its execution are experiencing barriers. Findings have emerged from two large studies: an evaluation of the 2006-2008 Australian Open Disclosure Pilot, and a 2009-2010 study of patients' and relatives' views on actual disclosures. Clinicians and patients interviewed in depth suggest that open disclosure communication has been prevented by a range of uncertainties, fears, and doubts.
Across Australia, 147 clinical staff were interviewed (mostly over the phone), and 142 patients and relatives were interviewed in their homes or over the phone. Interviews were recorded, transcribed, and analysed by three independent investigators. Transcription analyses yielded thematic domains, each with a range of ancillary issues.
Analysis of interview transcripts revealed several important barriers to disclosure: uncertainty among clinicians about what patients and family members regard as requiring disclosure; clinicians' assumption that those harmed are intent on blaming individuals and not interested in or capable of understanding the full complexity of clinical failures; concerns on the part of clinicians about how to interact with (angry or distressed) patients and family members; uncertainties about how to guide colleagues through disclosure; and doubts surrounding how to manage disclosure in the context of suspected litigation risk, qualified-privilege constraints, and risk-averse approaches adopted by insurers.
Disclosure practices appear to be inhibited by a wide range of barriers, only some of which have been previously reported. Strategies to overcome them are put forward for frontline clinicians, managerial staff, patient advocates, and policy agencies.
不良事件的事件披露作为事件管理、实践改进和公众参与的核心内容，正受到国际关注，但负责执行披露的人员却面临着诸多障碍。两项大型研究得出了相关结果：一项是对2006 - 2008年澳大利亚公开披露试点项目的评估，另一项是2009 - 2010年关于患者及其亲属对实际披露情况看法的研究。接受深度访谈的临床医生和患者表示，一系列的不确定性、恐惧和疑虑阻碍了公开披露的沟通。
在澳大利亚各地，对147名临床工作人员进行了访谈（大多通过电话），并对142名患者及其亲属进行了家访或电话访谈。访谈进行了录音、转录，并由三名独立调查员进行分析。转录分析得出了主题领域，每个主题领域都有一系列相关问题。
对访谈记录的分析揭示了披露存在几个重要障碍：临床医生不确定患者和家属认为哪些情况需要披露；临床医生认为受伤害者意图指责个人，对理解临床失误的全部复杂性不感兴趣或没有能力理解；临床医生担心如何与（愤怒或痛苦的）患者及其家属互动；不确定如何在披露过程中指导同事；以及在疑似诉讼风险、有限特权限制和保险公司采取的规避风险方法的背景下，对如何管理披露存在疑虑。
披露实践似乎受到多种障碍的抑制，其中只有一些障碍此前有过报道。针对一线临床医生、管理人员、患者权益倡导者和政策机构，提出了克服这些障碍的策略。
