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Original Investigation |

Surgeons’ Disclosures of Clinical Adverse Events ONLINE FIRST

A. Rani Elwy, PhD1,2,3; Kamal M. F. Itani, MD4,5; Barbara G. Bokhour, PhD2,3; Nora M. Mueller, MAA2,6; Mark E. Glickman, PhD2,7; Shibei Zhao, MPH2; Amy K. Rosen, PhD1,5; Dana Lynge, MD8,9; Melissa Perkal, MD10,11; Erica A. Brotschi, MD4,5; Vivian M. Sanchez, MD4,5; Thomas H. Gallagher, MD12,13
[+] Author Affiliations
1Center for Healthcare Organization and Implementation Research, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
2Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts
3Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts
4Department of Surgery, Veterans Affairs Boston Healthcare System, West Roxbury, Massachusetts
5Department of Surgery, Boston University School of Medicine, Boston, Massachusetts
6Department of Behavioral and Community Health, University of Maryland School of Public Health, College Park
7Department of Statistics, Harvard University, Cambridge, Massachusetts
8Department of Surgery, Veterans Affairs Puget Sound Healthcare System, Seattle, Washington
9Department of Surgery, University of Washington Healthcare System, Seattle
10Department of Surgery, Veterans Affairs Connecticut Healthcare System, West Haven
11Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
12Department of Bioethics, University of Washington Medical School, Seattle
13Department of Medicine, University of Washington Medical School, Seattle
JAMA Surg. Published online July 20, 2016. doi:10.1001/jamasurg.2016.1787
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Importance  Surgeons are frequently faced with clinical adverse events owing to the nature of their specialty, yet not all surgeons disclose these events to patients. To sustain open disclosure programs, it is essential to understand how surgeons are disclosing adverse events, factors that are associated with reporting such events, and the effect of disclosure on surgeons.

Objective  To quantitatively assess surgeons’ reports of disclosure of adverse events and aspects of their experiences with the disclosure process.

Design, Setting, and Participants  An observational study was conducted from January 1, 2011, to December 31, 2013, involving a 21-item baseline questionnaire administered to 67 of 75 surgeons (89%) representing 12 specialties at 3 Veterans Affairs medical centers. Sixty-two surveys of their communication about adverse events and experiences with disclosing such events were completed by 35 of these 67 surgeons (52%). Data were analyzed using mixed linear random-effects and logistic regression models.

Main Outcomes and Measures  Self-reports of disclosure assessed by 8 items from guidelines and pilot research, surgeons’ perceptions of the adverse event, reported personal effects from disclosure, and baseline attitudes toward disclosure.

Results  Most of the surgeons completing the web-based surveys (41 responses from men and 21 responses from women) used 5 of the 8 recommended disclosure items: explained why the event happened (55 of 60 surveys [92%]), expressed regret for what happened (52 of 60 [87%]), expressed concern for the patient’s welfare (57 of 60 [95%]), disclosed the adverse event within 24 hours (58 of 60 [97%]), and discussed steps taken to treat any subsequent problems (59 of 60 [98%]). Fewer surgeons apologized to patients (33 of 60 [55%]), discussed whether the event was preventable (33 of 60 [55%]), or how recurrences could be prevented (19 of 59 [32%]). Surgeons who were less likely to have discussed prevention (33 of 60 [55%]), those who stated the event was very or extremely serious (40 of 61 surveys [66%]), or reported very or somewhat difficult experiences discussing the event (16 of 61 [26%]) were more likely to have been negatively affected by the event. Surgeons with more negative attitudes about disclosure at baseline reported more anxiety about patients’ surgical outcomes or events following disclosure (odds ratio, 1.54; 95% CI, 1.16-2.06).

Conclusions and Relevance  Surgeons who reported they were less likely to discuss preventability of the adverse event, or who reported difficult communication experiences, were more negatively affected by disclosure than others. Quality improvement efforts focused on recognizing the association between disclosure and surgeons’ well-being may help sustain open disclosure policies.

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