Department of Pediatrics, New York University Grossman School of Medicine.
Department of Population Health, New York University Grossman School of Medicine, New York, New York.
J Patient Saf. 2022 Mar 1;18(2):e470-e476. doi: 10.1097/PTS.0000000000000848.
The aim of the study was to describe factors that may impact pediatric trainees' willingness to disclose medical errors using clinical vignettes.
A single-center cross-sectional anonymous survey of pediatric residents and fellows at a large urban medical center in 2019 was conducted. Trainees were provided with clinical vignettes depicting an error resulting in a serious safety event (SSE), minor safety event (MSE), and near miss safety event (NMSE) and were asked to classify the type of safety event and rate and explain their agreement or disagreement with disclosure. Survey items also evaluated trainees' personal experiences with errors and disclosure. Descriptive and correlational analyses were used to characterize responses. Qualitative content from open-ended survey questions was analyzed using the constant comparative method.
Of 126 trainees, 42 (33%) completed the survey. All agreed with disclosing the hypothetical error presented in the vignette resulting in an SSE (100%), with rates falling for the MSE (95%) and NMSE (7%). There were no significant associations between disclosure agreement for the vignettes and trainee demographic features, knowledge of safety events, prior personal experiences with errors, and disclosure. Four themes that emerged from qualitative analysis of trainees' rationales for disclosure or nondisclosure of the vignette errors are harm, parental preferences, ethical principles, and anticipatory guidance.
Trainees had high rates of disclosure for the vignette errors cases that depicted SSEs and MSEs but lower rates for NMSEs. Trainees considered the type and level of harm caused, parental preferences, upholding ethical principles, and the need for anticipatory guidance in their rationales for disclosure or nondisclosure of the vignette errors.
本研究旨在通过临床案例描述可能影响儿科受训者披露医疗错误意愿的因素。
2019 年，对一家大型城市医疗中心的儿科住院医师和研究员进行了一项单中心横断面匿名调查。向受训者提供了描述导致严重安全事件（SSE）、轻微安全事件（MSE）和接近错过安全事件（NMSE）的错误的临床案例，并要求他们对安全事件的类型进行分类，并对披露的同意或不同意进行评分和解释。调查项目还评估了受训者的错误和披露个人经历。使用描述性和相关性分析来描述反应。使用恒定性比较法对开放式调查问题的定性内容进行分析。
在 126 名受训者中，有 42 名（33%）完成了调查。所有人都同意披露案例中假设的 SSE 导致的错误（100%），而 MSE（95%）和 NMSE（7%）的披露率则下降。披露案例错误的同意率与受训者的人口统计学特征、对安全事件的了解、个人错误经历以及披露均无显著关联。从案例错误披露或不披露的原因的定性分析中出现了四个主题：伤害、家长偏好、伦理原则和预期指导。
受训者对案例中描述的 SSE 和 MSE 错误有很高的披露率，但对 NMSE 错误的披露率较低。受训者在披露或不披露案例错误时的理由考虑了所造成的伤害类型和程度、家长偏好、坚持伦理原则以及预期指导的需要。
