Facilitating and impeding factors for physicians' error disclosure: a structured literature review

Area of Science:

• Medical error disclosure
• Patient safety research
• Healthcare professional communication

Background:

• Physician disclosure of medical errors is crucial for patient safety, professional learning, and direct patient care.
• No comprehensive review previously existed on factors influencing medical error disclosure.
• Disclosure serves multiple stakeholders, including institutions, colleagues, and patients.

Purpose of the Study:

• To conduct a comprehensive review of factors that facilitate or impede the disclosure of medical errors.
• To identify and classify the primary goals of medical error disclosure.

Main Methods:

• A systematic literature search of MEDLINE (1975-2004) was performed.
• 5,509 articles were reviewed by title, 881 retrieved for full text, and 475 met inclusion criteria.
• Article content was analyzed for factors influencing disclosure and its primary goals.

Main Results:

• Thirty-five facilitating factors (e.g., accountability, honesty) and 41 impeding factors (e.g., legal liability, blame) were identified.
• The most common disclosure goals were improving patient safety, enhancing learning, and informing patients.
• Facilitating factors were more frequently cited when the disclosure goal was to inform patients.

Conclusions:

• Numerous factors can either facilitate or impede medical error disclosure.
• Future innovations should focus on removing impeding factors and promoting facilitating factors to enhance error disclosure.
• Addressing both barriers and enablers is essential for improving medical error reporting systems.