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Why Do Surgeons Fail to Disclose Medical Errors?
Vol. 219, No. 3S, September 2014
A sensitivity analysis using volume as a continuous variable was performed. RESULTS: Patients differed across volume quartiles in terms of characteristics and procedure mix. Volume quartiles were set at <21, 21-40, 40-78, >78 major elective lung operations per year. Patients >80 years old derived significantly greater absolute and relative adjusted mortality benefit than patients <60 years old in high- vs low-volume hospitals (>80 years old: 3.9% vs 1.2% p<0.0001, OR 3.38 (CI 1.92-5.93); <60 years old: 0.7% vs 0.5% p¼0.19, OR 1.61 (CI 0.86-2.99)). Analyses using volume as a continuous variable confirmed its association with mortality (p<0.0001). Median costs were not significantly increased across volume quartiles. CONCLUSIONS: Patients older than 80 y derive significant volume-outcome benefit, while patients less than 60 years old derive negligible benefit. Selective referral may not increase value in younger patients. Process-of-Care Utilization in Lung Cancer Surgery Meghan R Flanagan, MD, Thomas K Varghese, MD, MS, FACS, Leah M Backhus, MD, MPH, FACS, Douglas E Wood, MD, Michael S Mulligan, MD, FACS, Aaron M Cheng, MD, FACS, Rafael Alfonso-Cristancho, MD, MSc, PhD, David R Flum, MD, MPH, FACS, Farhood Farjah, MD, MPH University of Washington Medical Center, Seattle, WA INTRODUCTION: Process-of-care quality improvement initiatives can improve outcomes by standardizing practice patterns. Such standardization may improve surgical lung cancer outcomes; however, utilization of processes-of-care important in the preoperative assessment of surgically managed lung cancer patients has not been well characterized. METHODS: A retrospective cohort study (2007-2011) of resected lung cancer patients was conducted using MarketScan, a nationally representative employer-provided health insurance claims database. Five processes-of-care recommended by national guidelines for all surgically resectable patients were evaluated: pulmonary function testing (PFT), computed tomography (CT), positron-emission tomography (PET), bronchoscopy, and mediastinoscopy. ECG, recommended for select patients, was also evaluated. RESULTS: Among 14,040 resected lung cancer patients (median age 63 years, 49% male), none of the recommended processesof-care reached 100% utilization. PFT was highest at 83%, followed by CT, 74%; PET, 67%; bronchoscopy, 61%; and mediastinoscopy, 20%. Initial ECG was performed in 77% of patients, and one third of these patients received more than one ECG. 50% of patients also received more than one CT prior to surgery.
Surgical Forum Abstracts
S113
Use of non-invasive staging modalities increased as the interval for ascertaining use increased from 60 to 180 days prior to surgery (CT, 74% to 92%; PET, 67% to 83%). CONCLUSIONS: The percentage of patients receiving initial PFT, CT, bronchoscopy, and mediastinoscopy reveals underutilization relative to recommended standards. There is also evidence of potential overutilization of ECG and CT, and untimely utilization of CT and PET. Further efforts to decrease variability in the use of processes-of-care may improve the surgical management of lung cancer. Why Do Surgeons Fail to Disclose Medical Errors? Zeinab Alawadi, MD, Jason M Etchegaray, MD, PhD, Madelene Ottosen, Aitebureme Aigbe, MPH, Emily Webster, MPH, Lillian S Kao, MD, MS, FACS, Eric J Thomas, MD, MPH University of Texas Health Science Center-Houston, Houston, TX INTRODUCTION: Despite the high frequency of medical errors, healthcare providers often fail to disclose them to patients. This study aims to identify perceived barriers by surgeons to disclosing medical errors. METHODS: An electronic survey tool was administered to surgeons practicing at an attending level in four academic centers in Texas. They were asked to list the top three barriers not to disclose medical errors. Responses were analyzed for thematic content by three coders independently, with coders having expertise in nursing, medicine, public health, and qualitative analysis. Coding differences were discussed until consensus was reached. RESULTS: Fifty eight surgeons completed the survey. Fear of lawsuit/legal action was the main concern shared by the surgeons (52%), followed by fear of losing patient’s trust, embarrassment/ disappointment in self, and pride/ego (26%, 10%, 9% respectively). Other respondents cited lack of hospital administration and leadership’s support (9%), hospital or team work culture of not disclosing errors (9%), peer judgment/pressure (7%), and lack of training and knowledge of the appropriate process (7% each) as the main reasons for not disclosing errors. Language barrier and communication difficulty with the patients were not major concerns (3% and 2%). CONCLUSIONS: Fear of lawsuit and legal action remains the main concern surgeons share for not disclosing medical errors. Education regarding the processes in place for as well as legal implications of error disclosure as well as creation of an environment that removes barriers for clinicians to disclosing errors should be a priority for healthcare organizations.
A sensitivity analysis using volume as a continuous variable was performed. RESULTS: Patients differed across volume quartiles in terms of characteristics and procedure mix. Volume quartiles were set at <21, 21-40, 40-78, >78 major elective lung operations per year. Patients >80 years old derived significantly greater absolute and relative adjusted mortality benefit than patients <60 years old in high- vs low-volume hospitals (>80 years old: 3.9% vs 1.2% p<0.0001, OR 3.38 (CI 1.92-5.93); <60 years old: 0.7% vs 0.5% p¼0.19, OR 1.61 (CI 0.86-2.99)). Analyses using volume as a continuous variable confirmed its association with mortality (p<0.0001). Median costs were not significantly increased across volume quartiles. CONCLUSIONS: Patients older than 80 y derive significant volume-outcome benefit, while patients less than 60 years old derive negligible benefit. Selective referral may not increase value in younger patients. Process-of-Care Utilization in Lung Cancer Surgery Meghan R Flanagan, MD, Thomas K Varghese, MD, MS, FACS, Leah M Backhus, MD, MPH, FACS, Douglas E Wood, MD, Michael S Mulligan, MD, FACS, Aaron M Cheng, MD, FACS, Rafael Alfonso-Cristancho, MD, MSc, PhD, David R Flum, MD, MPH, FACS, Farhood Farjah, MD, MPH University of Washington Medical Center, Seattle, WA INTRODUCTION: Process-of-care quality improvement initiatives can improve outcomes by standardizing practice patterns. Such standardization may improve surgical lung cancer outcomes; however, utilization of processes-of-care important in the preoperative assessment of surgically managed lung cancer patients has not been well characterized. METHODS: A retrospective cohort study (2007-2011) of resected lung cancer patients was conducted using MarketScan, a nationally representative employer-provided health insurance claims database. Five processes-of-care recommended by national guidelines for all surgically resectable patients were evaluated: pulmonary function testing (PFT), computed tomography (CT), positron-emission tomography (PET), bronchoscopy, and mediastinoscopy. ECG, recommended for select patients, was also evaluated. RESULTS: Among 14,040 resected lung cancer patients (median age 63 years, 49% male), none of the recommended processesof-care reached 100% utilization. PFT was highest at 83%, followed by CT, 74%; PET, 67%; bronchoscopy, 61%; and mediastinoscopy, 20%. Initial ECG was performed in 77% of patients, and one third of these patients received more than one ECG. 50% of patients also received more than one CT prior to surgery.
Surgical Forum Abstracts
S113
Use of non-invasive staging modalities increased as the interval for ascertaining use increased from 60 to 180 days prior to surgery (CT, 74% to 92%; PET, 67% to 83%). CONCLUSIONS: The percentage of patients receiving initial PFT, CT, bronchoscopy, and mediastinoscopy reveals underutilization relative to recommended standards. There is also evidence of potential overutilization of ECG and CT, and untimely utilization of CT and PET. Further efforts to decrease variability in the use of processes-of-care may improve the surgical management of lung cancer. Why Do Surgeons Fail to Disclose Medical Errors? Zeinab Alawadi, MD, Jason M Etchegaray, MD, PhD, Madelene Ottosen, Aitebureme Aigbe, MPH, Emily Webster, MPH, Lillian S Kao, MD, MS, FACS, Eric J Thomas, MD, MPH University of Texas Health Science Center-Houston, Houston, TX INTRODUCTION: Despite the high frequency of medical errors, healthcare providers often fail to disclose them to patients. This study aims to identify perceived barriers by surgeons to disclosing medical errors. METHODS: An electronic survey tool was administered to surgeons practicing at an attending level in four academic centers in Texas. They were asked to list the top three barriers not to disclose medical errors. Responses were analyzed for thematic content by three coders independently, with coders having expertise in nursing, medicine, public health, and qualitative analysis. Coding differences were discussed until consensus was reached. RESULTS: Fifty eight surgeons completed the survey. Fear of lawsuit/legal action was the main concern shared by the surgeons (52%), followed by fear of losing patient’s trust, embarrassment/ disappointment in self, and pride/ego (26%, 10%, 9% respectively). Other respondents cited lack of hospital administration and leadership’s support (9%), hospital or team work culture of not disclosing errors (9%), peer judgment/pressure (7%), and lack of training and knowledge of the appropriate process (7% each) as the main reasons for not disclosing errors. Language barrier and communication difficulty with the patients were not major concerns (3% and 2%). CONCLUSIONS: Fear of lawsuit and legal action remains the main concern surgeons share for not disclosing medical errors. Education regarding the processes in place for as well as legal implications of error disclosure as well as creation of an environment that removes barriers for clinicians to disclosing errors should be a priority for healthcare organizations.