Disclosure of harmful medical errors in out-of-hospital care.

Safety experts and national guidelines recommend disclosing harmful medical errors to patients. Communicating with patients and families about errors respects their autonomy, supports informed decisionmaking, may decrease malpractice costs, and can enhance patient safety. Yet existing disclosure guidelines may not account for the difficulty in discussing out-of-hospital errors with patients. Emergency medical services (EMS) providers operate in unpredictable environments that require rapid interventions for patients with whom they have only brief relationships. EMS providers also have limited access to patient medical data and risk management resources, which can make conducting disclosure conversations even more difficult. In addition, out-of-hospital errors may be discovered only after the transition of care to the inpatient setting, further complicating the question of who should disclose the error. EMS organizations should support the disclosure of out-of-hospital errors by fostering a nonpunitive culture of error reporting and disclosure, as well as developing guidelines for use by EMS systems.