Teaching Disclosure: A Patient-Centered Simulation Training for the Crucial Conversation

Sara Sukalich, MD

Riverside Methodist Hospital, Columbus OH

Ohio Health Foundation

Unfortunately…

Mistakes happen

Patients and families want to know What happened? Why did it happen? Will it happen again?

Providers need to thoughtfully and honestly answer these questions

Medical Error Disclosure

Disclosure is bringing to light an unintended outcome Reinforces honesty and trust

Barriers The culture of medicine—help not harm Not taught in school Anxiety about facing mistake Difficulty apologizing Fear of litigation

Disclosure of a Medical Error is an Always Event

Following a medical error, physicians will always: Provide an explanation to the patient and family

regarding what happened Discuss potential implications or consequences of

error Commit to investigate what went wrong Give feedback regarding the findings of the

investigation Offer an apology or expression of regret

Patient-Centered Care Principles

Respect for patients’ values, preferences and expressed needs

Information, communication, and education Emotional support and alleviation of fear and

anxiety Involvement of family and friends

Project Overview

55 interns (four specialties) Simulation using standardized patient Multiple assessments

Self Attending Standardized patient

Review of video after simulation Self-study module

Scenario

66yo man after cardiovascular surgery Nurse notices change of mental status after

narcotic overdose Resident quickly realizes mistake and

reversal medicine administered Patient transferred to ICU for observation

Learner’s task is disclosure of error to family member

Goals

Decrease provider anxiety about disclosure Emphasize importance of

Clear, prompt communication Offering an apology Not placing blame Placing focus on patient’s immediate care Offering resources Assuring investigation

Project Progress

All interns have undergone 1st simulation All interns have completed interim self-study

On-line module about disclosure Policy review Learning styles inventory

2nd simulations underway

Preliminary Findings

Initial self assessment identified areas of weakness Knowing who to notify Whether to speculate about error or assign guilt

10 of 55 interns did not achieve passing composite score

Project well-received by residents, attendings, standardized patients, and staff of simulation center

Conclusions

Medical error disclosure should always occur Disclosure is stressful Simulation can teach correct approach to

disclose Simulation practice can help providers gain

confidence Teaching early in training important