Wu Albert W, McCay Layla, Levinson Wendy, Iedema Rick, Wallace Gordon, Boyle Dennis J, McDonald Timothy B, Bismark Marie M, Kraman Steve S, Forbes Emma, Conway James B, Gallagher Thomas H
From the *Center for Health Services and Outcomes Research, Johns Hopkins University, Baltimore, Maryland; †Global Alliance for Improved Nutrition (GAIN), Washington, DC; ‡University of Toronto, Toronto, Ontario, Canada; §University of Technology, Sydney, Australia; ∥Canadian Medical Protective Association (CMPA), Ottawa, Ontario, Canada; ¶University of Colorado, Denver, Colorado; #University of Illinois College of Medicine, Chicago, Illinois; **University of Melbourne, Melbourne, Australia; ††University of Kentucky, Lexington, Kentucky; ‡‡Health Quality & Safety Commission, Wellington, New Zealand; §§Institute for Healthcare Improvement (IHI), Boston, Massachusetts; and ∥∥University of Washington, Seattle, Washington.
J Patient Saf. 2017 Mar;13(1):43-49. doi: 10.1097/PTS.0000000000000107.
There is a growing expectation in health systems around the world that patients will be fully informed when adverse events occur. However, current disclosure practices often fall short of this expectation.
We reviewed trends in policy and practice in 5 countries with extensive experience with adverse event disclosure: the United States, the United Kingdom, Canada, New Zealand, and Australia.
We identified 5 themes that reflect key challenges to disclosure: (1) the challenge of putting policy into large-scale practice, (2) the conflict between patient safety theory and patient expectations, (3) the conflict between legal privilege for quality improvement and open disclosure, (4) the challenge of aligning open disclosure with liability compensation, and (5) the challenge of measurement related to disclosure.
Potential solutions include health worker education coupled with incentives to embed policy into practice, better communication about approaches beyond the punitive, legislation that allows both disclosure to patients and quality improvement protection for institutions, apology protection for providers, comprehensive disclosure programs that include patient compensation, delinking of patient compensation from regulatory scrutiny of disclosing physicians, legal and contractual requirements for disclosure, and better measurement of its occurrence and quality. A longer-term solution involves educating the public and health care workers about patient safety.
世界各地的卫生系统越来越期望在不良事件发生时让患者充分知情。然而，目前的披露做法往往达不到这一期望。
我们回顾了美国、英国、加拿大、新西兰和澳大利亚这5个在不良事件披露方面有丰富经验的国家的政策和实践趋势。
我们确定了反映披露面临的关键挑战的5个主题：（1）将政策付诸大规模实践的挑战；（2）患者安全理论与患者期望之间的冲突；（3）质量改进的法律特权与公开披露之间的冲突；（4）使公开披露与责任赔偿保持一致的挑战；（5）与披露相关的衡量挑战。
潜在的解决方案包括对卫生工作者进行教育并提供激励措施，以将政策融入实践；更好地就惩罚之外的方法进行沟通；制定允许向患者披露信息并为机构提供质量改进保护的立法；为提供者提供道歉保护；实施包括患者赔偿在内的全面披露计划；将患者赔偿与对披露医生的监管审查脱钩；制定披露的法律和合同要求；以及更好地衡量披露的发生情况和质量。一个长期的解决方案是对公众和卫生保健工作者进行患者安全方面的教育。
