DISCLOSURE WITH ADVERSE OUTCOMES AAOS Ethics Committee Kyle J. Jeray, MD 1.

Slides:

Advertisements

Similar presentations

Prevention & Disclosure of Medical Error Dr. Ramadan Ibrahim Director Health Regulation Department Dubai Health Authority.

Advertisements

Using Information Technology and Community-based Research to Improve the Dental Health Care System Kathryn A. Atchison, DDS, MPH Professor, Division of.

INFORMED CONSENT AAOS ETHICS COMMITTEE Paul Levin, MD 1.

Basic Law Criminal Law Civil Law. Criminal Law  Protects the public from harmful acts.

Transitions of Care: From Hospital to SNF Steven Tam, MD Assistant Clinical Professor UCI Program in Geriatrics, Internal Medicine.

“ PUT ME BACK IN DOC” Ethical Issues in Sports Medicine AAOS ETHICS COMMITTEE Nancy M. Cummings, MD 1.

Medical PROFESSIONALISM in the next millennium ABIM foundation ACP foundation European Federation of IM.

How to Avoid Medical Malpractice Suit Dr. Alia Al-Alawi.

Disclosure/Communication of Laboratory Errors Raouf E Nakhleh, MD Mayo Clinic Florida.

Building an ethics service | components | new questions and models | physician capacity | empirically driven.

Why barcode medications? Admin Rx at the Medical University of South Carolina.

Legal Implications for Nursing. Legal Terms Negligence –A general term that refers to conduct that does not show due care –Occurs when someone fails to.

Past, Present, Future December 6, 2004 Past, Present, Future December 6, 2004 Physicians, Hospitals and the Evolution of Electronic Medical Records (EMR)

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 07: Ethical Issues in Critical Care Nursing.

Second Opinions and Independent Medical Examinations (IMEs)

Healthcare Errors Error is defined as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim. By IOM.

ETHICAL ASPECTS of PLACEBO SURGERY AAOS ETHICS COMMITTEE Matthew J. Matava, MD 1.

SURROGATE DECISION MAKING AAOS ETHICS COMMITTEE Joan Krajca-Radcliffe, MD 1.

Safer Medication & Medical Devices Medication Safety & Hospital Admissions Avoidance 30 th June 2015 Dr Ahmed Ameer Medication Safety.

Principles of medical ethics Lecture (4) Dr. rawhia Dogham.

John W. C. Entwistle III, MD PhD Associate Professor of Surgery Thomas Jefferson University April 25, 2015.

Criteria and Standard.

THE OLDER SURGEON AAOS ETHICS COMMITTEE Stuart A. Green, MD 1.

THE ORTHOPAEDIC SURGEON’S RELATIONSHIPS WITH INDUSTRY AAOS ETHICS COMMITTEE Kenneth C. Thomas, MD 1.

AAOS ETHICS COMMITTEE Joan Krajca-Radcliffe, MD CONFIDENTIALITY 1.

PAYING to PLAY: Ethical Considerations in the Financial Arrangements between Orthopaedic Surgeons and Athletic Teams AAOS ETHICS COMMITTEE Matthew J. Matava,

What do patients and families need to know when errors occur? Susan Moffatt-Bruce MD, PhD, FACS, FRCS(C) Chief Quality and Patient Safety Officer Associate.

The Needs of Pediatric Practices for Policy and Procedures to Facilitate Youth with Special Health Care Needs (YSHCN) Transition to Adulthood. Patience.

ORTHOPAEDIC OPINION AND TESTIMONY

Introduction to Healthcare and Public Health in the US The Evolution and Reform of Healthcare in the US Lecture d This material (Comp1_Unit9d) was developed.

Medical Risk Management 1 st South American Congress Risk Management Santiago, Chile August 6 & 7, 2012 By: Geoffrey Hayton Claims Counsel for Adventist.

The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology This material (Comp2_Unit10a) was developed by Oregon Health and Science University,

THE IMPAIRED PHYSICIAN AAOS ETHICS COMMITTEE Timothy C. Wilson, MD 1.

A Teaching Hospital Challenge: Balancing Patient Care and Medical Student Education [Insert Name of Presenter] Ethics Resource Center American Medical.

PATIENT SAFETY : WHY? THEERAPAN SONGNUY DOCTOR OF MEDICINE ( CHULALONGKORN U.) BOARD OF PEDIATRIC ALLERGY & IMMUNOLOGY CERTIFICATE OF FAMILY MEDICINE MASTER.

Standard 4: Medication Safety Advice Centre Network Meeting Margaret Duguid Pharmaceutical Advisor February 2013.

SAYING SORRY IN CLINICAL PRACTICE R. Gyaneshwar Combined UOF/Sathya Sai Service Organisations Fiji Medical Seminar August 16, 2009.

PATIENT AUTONOMY AAOS ETHICS COMMITTEE Paul Levin, MD 1.

Assessment of Emergency Medicine Residents’ Bedside Communication Skills: A Survey of Emergency Department Patients Amanda Keller York College of PA Biology.

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 10Safety Concerns in Healthcare.

…a shared responsibility for health care How Medication Reconciliation Supports Patient Safety 15 September 2007 Jane Richardson, BSP, PhD, FCSHP Coordinator,

“One of America’s Best Hospitals” – U.S. News & World Report Medication Reconciliation JCAHO Patient safety Goal #8.

Patient Safety & Clinical Quality: Information Technology at THR Internal Medicine Update Presbyterian Hospital of Dallas October 29, 2003.

Disclosure of Medical Errors AND Risk Management

Disclosing Medical Errors: 2008 and Beyond Wendy Levinson, MD Professor of Medicine University of Toronto.

Physicians and Health Information Exchange (HIE) The Value of HIE to a Physician’s Practice and Consumers.

PATIENT ABANDONMENT AAOS ETHICS COMMITTEE Paul Levin, MD 1.

MAKING CARING CONNECTIONS CONTINUITY OF CARE TRANSFER PROJECT Staff Education Presentation LTC Facility Presenter’s Name Date.

Surgical safety is a serious public health issue About 234 million operations are done globally each year A rate of % deaths and 3-16% complications.

Continuity of Care Components of a Meaningful Primary Care Visit Pre-VisitVisitPost-VisitInter-Visit Review notes – your last note, any notes by other.

By Shahzad Ali MPharm. Understand Drivers For Change Understand current and future requirements What standards need to be adhered to Types of interfaces.

Mount Auburn Practice Improvement Program (MA-PIP)

JUST SAY NO Ethical Considerations of Patient Care in the Gray Zone AAOS ETHICS COMMITTEE Nancy M. Cummings, MD 1.

Conscientious Refusal in Residency Training Jennifer Frank, MD, FAAFP Fox Valley FMR Program November 12, 2009.

 Promote health, prevent illness/injury  Broad knowledge base needed to meet patient needs in different health care settings.

Health Information Technology Summit John Tooker, MD, MBA, FACP Executive Vice President/CEO American College of Physicians Washington, DC October 21,

0 Delegation of Services & Co-management The Co-management Dilemma.

Awareness of the National Standards for Culturally and Linguistically Appropriate Services (CLAS) at an Academic Health Center Dr. Genny Carrillo Department.

V2.0 University Health Network DISCHARGE SUMMARY.

History of Health Information Technology in the U.S.

Spotlight Case June 2004 The Wrong Shot: Error Disclosure.

Future research perspectives on Patient Safety in Primary Care: The View from Australasia Susan Dovey University of Otago Dunedin, New Zealand.

Spotlight Case October 2003 Hemivulvectomy: Wrong Side Removed.

Patient Care & Ethical Dilemmas

MULTI DISPLINARY CARE.. . PATIENT PHYSICIANNURSESOTHERSDIETITIANPHYSIOTHERAPIST.

Thomas R McLean, MD, JD, FACS, ESQ.

Disclosing and Resolving Adverse Outcomes

Professional Associations & Position Statements Training UPDATE

What Should a Mission Do?

Clinical Practice Guidelines: What, Why, Who?

Presentation transcript:

DISCLOSURE WITH ADVERSE OUTCOMES AAOS Ethics Committee Kyle J. Jeray, MD 1

Objectives Define a medical error Identify disclosure obligations to patient and family Identify responsible parties relating to disclosure What is the purpose of an apology and why do they sometimes fail? 2

40,000 Americans die every year because of medical errors. How do we define an error? 4

Errors  Acts  Omissions  May or may not result in harm/undesired outcomes 5

Case 1 A 56 year-old undergoes a lumbar spinal fusion and during the case a pedicle screw is placed into the vertebral foramen. Stockbyte/Thinkstock It is recognized and changed during the case. Postoperatively the patient has a foot drop. 5

What is the responsibility of the attending surgeon? What is the responsibility of the resident physician? 6

Do you apologize? What constitutes a successful apology? Why do apologies fail? 7

What are the ethical issues? What are the practical issues? Altered lifestyle? Bracing? Future surgery? Etc. 8

Who is responsible for increased cost? What are the medicolegal issues? 9

Case 1 - Altered What if the resident was left to close the wound and a sponge is left in the patient that is recognized on a post-op film Stockbyte/Thinkstock in the office at 2 weeks? 10

Is there a change in responsibility? 11

Case 2 During a routine decompression for a herniated disc, the surgeon inadvertently tears the dura. Medioimages/Photodisc/Thinkstock It is a small tear easily repaired and does not change the post op course. 12

Is this error different? Does the surgeon have a responsibility to disclose? 13

Case 3 Your office nurse calls you about a post-op wound that looks infected, and you ask him to begin antibiotics. The nurse writes a iStockphoto/Thinkstock prescription for a sulfonamide antibiotic. The patient gets it filled and did not recognize that he is allergic to the medicine as he has a documented sulfa allergy. He ends up in the ER, is treated, released, and changed to an appropriate antibiotic. 14

What is the responsibility of:  The physician?  The medical system (i.e. pharmacist)?  The nurse?  The patient? 15

Summary  The decision to admit or acknowledge an error should be based on ethical guidelines.  Disclosure is often difficult, but failure to do so can damage credibility and compromise integrity destroying the physician- patient relationship. 16

 By learning from and admitting errors, the quality of medical care is enhanced for all. 17

References American Academy of Orthopaedic Surgeons: Code of Ethics and Professionalism for Orthopaedic Surgeons, I.A., I.F., II.A., II.B. Adopted October 1988, revised American Academy of Orthopaedic Surgeons: Standards of Professionalism on Providing Musculoskeletal Services to Patients, Mandatory Standard 4. Adopted April 18, 2005, amended April 24, American Academy of Orthopaedic Surgeons: Communicating Adverse Events or Poor Outcomes, Information Statement Adopted 2004, revised

American Academy of Orthopaedic Surgeons: Wrong-Site Surgery, Information Statement Adopted 1997, revised Kohn L, Corrigan J, Donaldson M, (eds). To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press, Gallagher T, Studdert D, Levinson W: Disclosing harmful medical errors to patients. N Engl J Med 2007;356: Blendon R, DesRoches C, Brodie M, et al: Views of practicing physicians and the public on medical errors. N Engl J Med 2002;347:

Lo B: Resolving Ethical Dilemmas, A Guide for Clinicians. Philadelphia: Lippincott Williams & Wilkins, PA; ed 4; Gallagher T, Garbutt J, Waterman A, et al: Choosing your words carefully: How physicians would disclose harmful errors to patients. Arch Intern Med 2006;166: Lazare A: Apology in medical practice: An emerging clinical skill. JAMA 2006; 296: Zimmerman R: Doctors’ new tool to fight lawsuits: saying “I’m sorry.” Wall Street Journal. May 18, 2004:A1. 20

Gertner R: The art of apologizing takes hold in the legal world. St Louis Daily Record. December 22, Lazare A: On Apology. New York, NY, Oxford University Press, Ring D, Herndon J, Meyer G: Case : A 65— year-old woman with an incorrect operation on the left hand. N Engl J Med, November 11, Council on Ethical and Judicial Affairs: Code of Medical Ethics, Opinions 8.12, 8.121, Chicago, IL, American Medical Association, ed 2010 –