Disclosing Medical Errors: We Can Afford to Do the Right Thing

1Brigham &
Women's Hospital, Boston, MA
2University of Michigan, Ann Arbor, Ml
3University of Michigan, Ann Arbor, Ml
4University of Michigan, Ann Arbor, Ml
5University of Michigan, Ann Arbor, Ml
6University of Michigan, Ann Arbor, Ml
7University of Michigan, Ann Arbor, Ml

Meeting: Hospital Medicine 2010, April 8-11, Washington, D.C.

Abstract number: 73

Background:

Ethical obligations and patient safety principles support prompt and full disclosure of harmful medical errors. In an era of high malpractice premiums, debate on whether disclosure increases or decreases liability claims and costs persists. Empirical data to help answer the question remain sparse. Since 2001, the University of Michigan Health System (UMHS) has operated a risk management model of full disclosure with the offer of compensation for harmful medical errors. The liability‐related performance of this model — set in a public academic medical center serving a diverse patient population — can help inform the debate.

Methods:

We conducted a retrospective before‐and‐after analysis on UMHS malpractice claims‐related performance from 1995 to 2007. Several indicators related to malpractice claims were evaluated, including number of new claims for compensation, number of claims compensated, legal and patient compensation costs, and time to claim resolution. To account for clinical activity, data were analyzed as monthly rates of new claims (per patient contacts — total in patient and outpatient visits) and monthly cost rates (per operating revenue).

Results:

After the adoption of a model of full disclosure with offer of compensation, the mean monthly rate of new claims (per 100,000 patient contacts) for UMHS decreased 36% (95% Cl: 5%–56%), from 7.03 to 4.52. The rate of claims resulting in lawsuits declined by 65% (95% Cl: 42%–78%), from 2.13 to 0.75, although the rate of all other types of claims did not significantly decrease (4.90 vs. 3.77). The average number of claims compensated decreased from 53.2 to 31.7 per year. Claims were also resolved more quickly with the disclosure model (median time: 16 vs. 11 months, P < 0.001). Mean liability costs per month (per $1000 operating revenue) decreased by 59% ($18.91 vs. $778, P < 0.001) after the disclosure model was implemented, driven by a decrease in both legal costs ($2.26 vs. $0.88, P < 0.001) and patient compensation costs ($16.64 vs. $6.90, P < 0.001).

Conclusions:

An approach that provides full disclosure of medical error coupled with an offer of compensation can serve ethical obligations and patient safety efforts without increasing malpractice‐related claims and costs.

Author Disclosure:

A. Kachalia, none; S. R. Kaufman, none; R. Boothman, none; S. Anderson, none; K. Welch, none; S. Saint, none; M. Rogers, none.

To cite this abstract:

Kachalia A, Kaufman S, Boothman R, Anderson S, Welch K, Saint S, Rogers M. Disclosing Medical Errors: We Can Afford to Do the Right Thing. Abstract published at Hospital Medicine 2010, April 8-11, Washington, D.C. Abstract 73. Journal of Hospital Medicine. 2010; 5 (suppl 1). https://www.shmabstracts.com/abstract/disclosing-medical-errors-we-can-afford-to-do-the-right-thing/. Accessed November 19, 2019.

« Back to Hospital Medicine 2010, April 8-11, Washington, D.C.