From the Medical School, University of Michigan.
Center for Bioethics and Social Sciences in Medicine.
J Patient Saf. 2021 Dec 1;17(8):e1765-e1773. doi: 10.1097/PTS.0000000000000625.
Patient safety programs aim to improve transparency regarding medical errors, and there is broad consensus on how providers should communicate about their own errors. How providers should respond to other providers' errors is less clear, especially when they occur outside the provider's facility or system (intersystem medical error discovery [IMED]). To understand what guidance is available to healthcare professionals in this scenario, we conducted a document analysis of ethical guidelines.
We searched for ethics codes primarily using databases and lists of professional associations. We used thematic analysis to examine documents in relation to our research questions: is there guidance on (a) what a provider should do after discovering another provider's error that occurred in a different health system, (b) interacting with other providers, or (c) other subjects relevant to IMED?
Our search identified 150 documents from 120 organizations. These documents contained ambiguous terminology and guidance limiting practical application to IMED scenarios, with most guidance potentially applicable to IMED rendered irrelevant to most IMED scenarios by its restriction to incompetence. In addition, guidelines often sent conflicting signals about prioritizing honesty with and autonomy of patients versus not criticizing the care provided by a fellow practitioner.
Ethics codes provide little guidance on communication regarding IMED scenarios, and in some cases, the guidance is internally conflicting. National professional and patient safety organizations should work to provide a framework for providers and facilities to communicate regarding these ethically and professionally challenging scenarios.
患者安全计划旨在提高医疗差错透明度，对于医务人员应如何就自身差错进行沟通，已达成广泛共识。然而，对于医务人员应如何应对其他医务人员的差错，尤其是当这些差错发生在医疗机构或系统之外（跨系统医疗差错发现[IMED]）时，情况则不那么明晰。为了解在这种情况下医疗保健专业人员可获得哪些指导，我们对伦理准则进行了文件分析。
我们主要使用数据库和专业协会列表搜索伦理准则。我们采用主题分析，根据以下研究问题来研究文件：是否有关于（a）在发现另一个发生在不同医疗系统中的提供者的差错后提供者应采取的措施，（b）与其他提供者互动，或（c）与 IMED 相关的其他主题的指导？
我们的搜索从 120 个组织中确定了 150 份文件。这些文件包含模糊的术语和指导，将实用应用限制在 IMED 场景中，由于将指导限定为无能，因此大多数指导对于大多数 IMED 场景可能适用，但对于大多数 IMED 场景来说并不相关。此外，准则经常在优先考虑患者的诚实和自主权与不批评同行提供的护理之间发出相互矛盾的信号。
伦理准则几乎没有提供有关 IMED 场景沟通的指导，在某些情况下，指导内容相互矛盾。国家专业和患者安全组织应努力为提供者和医疗机构提供一个框架，以便就这些具有伦理和专业挑战性的场景进行沟通。
