Lipira Lauren E, Gallagher Thomas H
Department of Medicine, University of Washington, Seattle, WA, USA,
World J Surg. 2014 Jul;38(7):1614-21. doi: 10.1007/s00268-014-2564-5.
The disclosure of adverse events to patients, including those caused by medical errors, is a critical part of patient-centered healthcare and a fundamental component of patient safety and quality improvement. Disclosure benefits patients, providers, and healthcare institutions. However, the act of disclosure can be difficult for physicians. Surgeons struggle with disclosure in unique ways compared with other specialties, and disclosure in the surgical setting has specific challenges. The frequency of surgical adverse events along with a dysfunctional tort system, the team structure of surgical staff, and obstacles created inadvertently by existing surgical patient safety initiatives may contribute to an environment not conducive to disclosure. Fortunately, there are multiple strategies to address these barriers. Participation in communication and resolution programs, integration of Just Culture principles, surgical team disclosure planning, refinement of informed consent and morbidity and mortality processes, surgery-specific professional standards, and understanding the complexities of disclosing other clinicians' errors all have the potential to help surgeons provide patients with complete, satisfactory disclosures. Improvement in the regularity and quality of disclosures after surgical adverse events and errors will be key as the field of patient safety continues to advance.
向患者披露不良事件，包括由医疗差错导致的不良事件，是以患者为中心的医疗保健的关键部分，也是患者安全和质量改进的基本要素。披露对患者、医疗服务提供者和医疗机构都有益处。然而，对医生来说，披露行为可能具有难度。与其他专科相比，外科医生在披露方面面临着独特的困难，而且在手术场景中的披露存在特定挑战。手术不良事件的发生频率，加上功能失调的侵权责任制度、手术医护人员的团队结构，以及现有手术患者安全举措无意中造成的障碍，可能导致不利于披露的环境。幸运的是，有多种策略可以应对这些障碍。参与沟通与解决计划、融入公正文化原则、进行手术团队披露规划、完善知情同意以及发病率和死亡率流程、制定手术特定的专业标准，以及理解披露其他临床医生差错的复杂性，所有这些都有可能帮助外科医生向患者提供完整、令人满意的披露。随着患者安全领域不断发展，提高手术不良事件和差错后披露的规律性和质量将是关键。
