Does Your Service Report Medical Errors To THE PATIENT ?

[tcripp]

Interesting thread. Makes you say, "hmmm". The short answer to your question is, "I don't know". I'll have to ask when I go on shift next.

However, should we as individuals be disclosing that information? I do not believe that is our place. That decision belongs to our Chief and Medical Director. What we should be doing is disclosing accurately in our reports what occurred. Let me repeat...accurately.

Just curious in the example you have cited. Were you there (the partner) or is this hearsay? Other signs/symptoms that would lead the medic to believe coronary and not trauma related as the patient stated? Did the patient decide that he wanted to go POV and the team just jumped on it or did they encourage the refusal themselves? Regardless of which path, did they encourage the patient to go immediately and he delayed (you said 2.5 hours)? I'd really like to see more detail before we hang this crew...

I've said it before and I will say it again. EMS is not an exact science and mistakes will be made. It's how we deal with those mistakes that defines us.

[flamingemt2011]

Ak you do not know that will happen. They may or may not sue. And your employer should not fire u for 1 miistake.

I was not there, and there were reversal versions to the story, but regardless, we know mistakes happen routinely, just google Washington dc ems

Edited October 27, 2011 by flamingemt2011

[Bieber]

Talking about medical error, I think that one of the most important things we've realized is that more often than not it's not a provider error but a system failure. Does the system promote the reporting of mistakes for the purpose of non-punitive correction of aberrant or potentially dangerous behaviors, or is perfection (unrealistically) expected and failure to achieve that met with harsh, unhelpful punitive responses by administrative personnel?

At my service, we've recently changed the way we approach provider error. Mistakes are classified as either unavoidable human error ("I meant to push X drug but pushed Y drug instead, unintentionally and accidentally"), mistakes from at-risk behavior ("I meant to push X drug, even though Y drug was the correct choice"), and dangerous behavior ("I know that Y drug is the correct one to push, but I pushed Y drug nonetheless").

Our new system includes non-punitive coaching for at-risk behavior, along with remediation if necessary so that the mistake will not be repeated ("let's find out why you thought X drug was correct, even though Y drug was") which includes trying to understand WHY the provider thought that their actions were correct in that situation WITH the knowledge that they had at the time. For dangerous behavior, punitive actions will remain in place, but the primary goal of our current system is to REDUCE medical error, not just PUNISH medical error, taking the principles and learnings of the airline industry and applying them to our own system.

With regards to reporting medical error, I think that there isn't a straight answer to it. First, what was the cause of the medical error? Was it due to unavoidable human error? At-risk behavior? Dangerous behavior? What were the damages resulting from the mistake? Was there a change in the patient's prognosis following the error? If I mistake an anxiety attack for an allergic reaction in a pediatric patient and give the patient IM epinephrine (true story, not mine), was a mistake made? Yes. Was it due to dangerous behavior, at-risk behavior, or human error? In this case, it's safe to say that it wasn't due to dangerous behavior; most likely it was due to at-risk behavior (failure to identify the correct condition). And finally, what is the patient's prognosis? I think that in the absence of additional risk factors or unforeseen complications, it's safe to say that while the patient may experience some discomfort for a while, their prognosis remains good.

Does this need to be reported? I think so, but it must be done with extreme care to make sure that the parent understands why the mistake was made, and above all else that the patient is unlikely to suffer permanent or long-term damage as a result of the error. But what about the code blue asystolic patient who's obviously been down for a while and has a massive history of heart problems, COPD, hypertension, diabetes, etc, who's line infiltrated after placement and, as it turns out, none of the drugs pushed made it into the systemic circulation? The provider failed to notice it until after they had retriaged code black and were covering the patient with a sheet. Was a mistake made? Yes. Was it a dangerous mistake? No. Did the mistake likely change the patient's prognosis? Probably not. Will the family benefit from learning about this mistake? No.

Anyway, like I said, like so much in medicine, I think that this is a dynamic, not a static issue, and that it's very much situational. There are times when we absolutely have to report the mistake to the family, but I don't think that reporting every single mistake would benefit either the families or the providers either.

-Bieber

[DwayneEMTP]

I'm asking again, Flaming, HLPPs.....

You continue to rant and be disappointed in our moral and ethical behavior in this field, yet who, in this entire thread has made the argument that it's ok to cover up life ending/altering mistakes? Who....Did.....That?

Dwayne

[flamingemt2011]

Everyone that is against reporting errors because it might cost their job dwayne

[DwayneEMTP]

Everyone that is against reporting errors because it might cost their job dwayne

See man, this is the bullshit that makes it near impossible to take you seriously. It was a simple question...

Who has done that here?

Dwayne

[DFIB]

This argument keeps skipping between the responsibility of the provider to truthfully report and what the medical director decides to do with the Medics' Report.

As a provider i will always report in a true and accurate manner. Once the Medical direction, red tape gods, or powers that be get my true and accurate report the course of action is theirs. I cannot and will not be responsible for what others do. Nor will I spend my life worrying if the next guy did the right thing. I am sure that if a patients' family wants the record they can have it. I can only be truthful and accurate. When I am the boss I will make those decisions, in the mean time .....

This whole idea of some utopist panacea of what others should be doing, that I have no control over, makes my head spin.

Does anyone know what the law requires as far as patient disclosure?

[DwayneEMTP]

...Does anyone know what the law requires as far as patient disclosure?

Now there's an interesting concept...considering the law...

Dwayne

[ERDoc]

I've purposely stayed out of this but figured it was time to throw my 2 cents in. There is a big push in medicine to admit errors. The literature has shown that when errors are disclosed in a proper manner and setting that the risk of being sued for a bad outcome decreases (though it does not go to 0%). Several states have passed legislation that allows providers to disclose and appologize for an error and not allow it to be used in a court as an admission of guilt. I don't know if it applies to EMS.

As for EMS, you need to be honest with the hospital staff as it may affect our treatment plan and decisions. We all make mistakes, it's human. Sure, the nurses will probably grumble and bitch. As for reporting it to your company, that's a tough call, you have to know your organization. In a utopia, you should be able to report it to the company for them to review with fear of punishment, similar to what Beiber said. The airlines do this all the time. If they file a NASA form they are protected from punishment (oversimplification but you get the idea).

There are some errors that just don't matter. I recently had an EMS crew bring in a 39 week pregnant woman from an MVA. They had her laying on her right side. :facepalm: We took her off the board, no harm done. There was no need to tell the pt. The only thing it would have done was make the medic look like an idiot in front of the pt. It was a great opportunity for education. I pulled the medic aside and just explained what was wrong, why it was wrong and what to do next time. He was thankful and that was the end of it.

I think one of the problems we face in medicine is that people will blaming things on something that has not causation. Let's say you give a pt the wrong med and there is no bad outcome. They develop some "chronic back pain" a few weeks later. They will now blame you for their pain and suffering. A sympathetic jury will award them damages.

[DFIB]

There are some errors that just don't matter. I recently had an EMS crew bring in a 39 week pregnant woman from an MVA. They had her laying on her right side. :facepalm: We took her off the board, no harm done. There was no need to tell the pt. The only thing it would have done was make the medic look like an idiot in front of the pt. It was a great opportunity for education. I pulled the medic aside and just explained what was wrong, why it was wrong and what to do next time. He was thankful and that was the end of it.

That was really cool that you would take the time to explain the rationale to the EMT. I assume it was a EMT because a medic should have known. I am sure that it is a lesson he will not soon forget.

It means a lot to us EMT's when a Dr. takes the opportunity to tutor us. Being at the bottom of the EMS food chain it is easy to begin to believe that our care doesn't really make that much of a difference. That you showed him respect by pointing out the error in a teaching enviroment had to have been uplifting. You might have changed the guys’ entire career perspective.

Edited October 28, 2011 by DFIB