Kimberly A Fisher1, Sumera Ahmad2, Madeline Jackson3, Kathleen M Mazor4. 1. Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA; Meyers Primary Care Institute, 425 North Lake Avenue, Worcester, MA 01605, USA. Electronic address: kimberly.fisher@umassmemorial.org. 2. Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA. 3. Meyers Primary Care Institute, 425 North Lake Avenue, Worcester, MA 01605, USA. 4. Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655, USA; Meyers Primary Care Institute, 425 North Lake Avenue, Worcester, MA 01605, USA.
Abstract
OBJECTIVE: To describe surrogate decision makers' (SDMs) perspectives on preventable breakdowns in care among critically ill patients. METHODS: We screened 70 SDMs of critically ill patients for those who identified a preventable breakdown in care, defined as an event where the SDM believes something "went wrong", that could have been prevented, and resulted in harm. In-depth interviews were conducted with SDMs who identified an eligible event. RESULTS: 32 of 70 participants (46%) identified at least one preventable breakdown in care, with a total of 75 discrete events. Types of breakdowns involved medical care (n=52), communication (n=59), and both (n=40). Four additional breakdowns were related to problems with SDM bedside access to the patient. Adverse consequences of breakdowns included physical harm, need for additional medical care, emotional distress, pain, suffering, loss of trust, life disruption, impaired decision making, and financial expense. 28 of 32 SDMs raised their concerns with clinicians, yet only 25% were satisfactorily addressed. CONCLUSION: SDMs of critically ill patients frequently identify preventable breakdowns in care which result in harm. PRACTICE IMPLICATIONS: An in-depth understanding of the types of events SDMs find problematic and the associated harms is an important step towards improving the safety and patient-centeredness of healthcare.
OBJECTIVE: To describe surrogate decision makers' (SDMs) perspectives on preventable breakdowns in care among critically illpatients. METHODS: We screened 70 SDMs of critically illpatients for those who identified a preventable breakdown in care, defined as an event where the SDM believes something "went wrong", that could have been prevented, and resulted in harm. In-depth interviews were conducted with SDMs who identified an eligible event. RESULTS: 32 of 70 participants (46%) identified at least one preventable breakdown in care, with a total of 75 discrete events. Types of breakdowns involved medical care (n=52), communication (n=59), and both (n=40). Four additional breakdowns were related to problems with SDM bedside access to the patient. Adverse consequences of breakdowns included physical harm, need for additional medical care, emotional distress, pain, suffering, loss of trust, life disruption, impaired decision making, and financial expense. 28 of 32 SDMs raised their concerns with clinicians, yet only 25% were satisfactorily addressed. CONCLUSION: SDMs of critically illpatients frequently identify preventable breakdowns in care which result in harm. PRACTICE IMPLICATIONS: An in-depth understanding of the types of events SDMs find problematic and the associated harms is an important step towards improving the safety and patient-centeredness of healthcare.
Authors: Kimberly A Fisher; Thomas H Gallagher; Kelly M Smith; Yanhua Zhou; Sybil Crawford; Azraa Amroze; Kathleen M Mazor Journal: BMJ Qual Saf Date: 2019-11-13 Impact factor: 7.035
Authors: Kathleen M Mazor; Aruna Kamineni; Douglas W Roblin; Jane Anau; Brandi E Robinson; Benjamin Dunlap; Cassandra Firneno; Thomas H Gallagher Journal: J Patient Saf Date: 2021-12-01 Impact factor: 2.844
Authors: Sigall K Bell; Stephanie D Roche; Ariel Mueller; Erica Dente; Kristin O'Reilly; Barbara Sarnoff Lee; Kenneth Sands; Daniel Talmor; Samuel M Brown Journal: BMJ Qual Saf Date: 2018-07-12 Impact factor: 7.035