Allen Kachalia (
Kenneth Sands is chief epidemiologist and chief patient safety officer at HCA Healthcare, in Nashville, Tennessee.
Health Aff (Millwood). 2018 Nov;37(11):1836-1844. doi: 10.1377/hlthaff.2018.0720.
To promote communication with patients after medical injuries and improve patient safety, numerous hospitals have implemented communication-and-resolution programs (CRPs). Through these programs, hospitals communicate transparently with patients after adverse events; investigate what happened and offer an explanation; and, when warranted, apologize, take responsibility, and proactively offer compensation. Despite growing consensus that CRPs are the right thing to do, concerns over liability risks remain. We evaluated the liability effects of CRP implementation at four Massachusetts hospitals by examining before-and-after trends in claims volume, cost, and time to resolution and comparing them to trends among nonimplementing peer institutions. CRP implementation was associated with improved trends in the rate of new claims and legal defense costs at some hospitals, but it did not significantly alter trends in other outcomes. None of the hospitals experienced worsening liability trends after CRP implementation, which suggests that transparency, apology, and proactive compensation can be pursued without adverse financial consequences.
为促进医疗伤害后与患者的沟通,提高患者安全,许多医院实施了沟通与解决计划(CRPs)。通过这些计划,医院在不良事件后与患者进行透明沟通;调查发生了什么,并提供解释;在有必要时,道歉、承担责任并主动提供赔偿。尽管越来越多的人认为 CRPs 是正确的做法,但对责任风险的担忧仍然存在。我们通过检查四个马萨诸塞州医院的索赔数量、成本和解决时间的前后趋势,并将其与未实施同行机构的趋势进行比较,评估了 CRP 实施的责任影响。CRP 实施与一些医院新索赔率和法律辩护成本的改善趋势相关,但并未显著改变其他结果的趋势。在 CRP 实施后,没有一家医院的责任趋势恶化,这表明透明度、道歉和主动赔偿可以在没有不利财务后果的情况下实施。