Yale University Yale School of Public Health, New Haven, Connecticut, USA.
Yale University Yale School of Public Health, New Haven, Connecticut, USA
BMJ Open Qual. 2024 Aug 15;13(3):e002848. doi: 10.1136/bmjoq-2024-002848.
Adverse medical events affect 10% of American households annually, inducing a variety of harms and attitudinal changes. The impact of adverse events on perceived abandonment by patients and their care partners has not been methodically assessed.
To identify ways in which providers, patients and families responded to medical mishaps, linking these qualitatively and statistically to reported feelings of abandonment and sequelae induced by perceived abandonment.
Mixed-methods analysis of responses to the Massachusetts Medical Errors Recontact survey with participants reporting a medical error within the past 5 years. The survey consisted of forty closed and open-ended questions examining adverse medical events and their consequences. Respondents were asked whether they felt 'that the doctors abandoned or betrayed you or your family'. Open-ended responses were analysed with a coding schema by two clinician coders.
Of the 253 respondents, 34.5% initially and 20% persistently experienced abandonment. Perceived abandonment could be traced to interactions before (18%), during (34%) and after (45%) the medical mishap. Comprehensive post-incident communication reduced abandonment for patients staying with the provider associated with the mishap. However, 68.4% of patients perceiving abandonment left their original provider; for them, post-error communication did not increase the probability of resolution. Abandonment accounted for half the post-event loss of trust in clinicians.
Survey-based data may under-report the impact of perceived errors on vulnerable populations. Moreover, patients may not be cognizant of all forms of adverse events or all sequelae to those events. Our data were drawn from a single state and time period.
Addressing the deleterious impact of persisting abandonment merits attention in programmes responding to patient safety concerns. Enhancing patient engagement in the aftermath of an adverse medical event has the potential to reinforce therapeutic alliances between patients and their subsequent clinicians.
每年有 10%的美国家庭会遭遇不良医疗事件，导致各种伤害和态度变化。医疗事故对患者及其护理伙伴的被遗弃感的影响尚未得到系统评估。
确定医疗事故发生后，医务人员、患者及其家属的应对方式，并将这些应对方式与报告的被遗弃感及其引发的遗弃感后效进行定性和统计关联。
对过去 5 年内报告医疗差错的马萨诸塞州医疗差错再联络调查的参与者进行混合方法分析。该调查包括四十个封闭和开放式问题，考察不良医疗事件及其后果。受访者被问及是否感到“医生抛弃或背叛了你或你的家人”。对开放式回答进行了两位临床编码员使用编码方案的分析。
在 253 名受访者中，34.5%的人最初和 20%的人持续感到被遗弃。感知到的遗弃感可以追溯到医疗事故发生前（18%）、发生时（34%）和发生后（45%）的互动。全面的事件后沟通减少了与事故相关的患者对医务人员的遗弃感。然而，68.4%感知到被遗弃的患者离开了他们原来的提供者；对他们来说，错误后沟通并没有增加解决问题的可能性。遗弃感导致患者对医务人员信任度在事件后下降一半。
基于调查的数据可能低估了感知错误对弱势群体的影响。此外，患者可能没有意识到所有形式的不良事件或这些事件的所有后果。我们的数据来自一个州和一个时间点。
解决持续遗弃的不良影响值得在应对患者安全问题的项目中得到关注。在不良医疗事件发生后，增强患者的参与度有可能加强患者与随后的医务人员之间的治疗联盟。
