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Pediatricians' Attitudes and Behaviors

Jane Garbutt, MBChB; Dena R. Brownstein, MD; Eileen J. Klein, MD, MPH; Amy Waterman, PhD; Melissa J. Krauss, MPH; Edgar K. Marcuse, MD, MPH; Erik Hazel, PhD; Wm. Claiborne Dunagan, MD; Victoria Fraser, MD; Thomas H. Gallagher, MD

Arch Pediatr Adolesc Med. 2007;161(2):179-185.

Objective  To characterize pediatricians' attitudes and experiences regarding communicating about errors with the hospital and patients' families.

Design  Cross-sectional survey.

Setting  St Louis, Mo, and Seattle, Wash.

Participants  University-affiliated hospital and community pediatricians and pediatric residents.

Main Exposure  Anonymous 68-item survey (paper or Web-based) administered between July 2003 and March 2004.

Main Outcome Measures  Physician attitudes and experiences about error communication.

Results  Four hundred thirty-nine pediatric attending physicians and 118 residents participated (62% response rate). Most respondents had been involved in an error (39%, serious; 72%, minor; 61%, near miss; 7%, none). Respondents endorsed reporting errors to the hospital (97%, serious; 90%, minor; 82%, near miss), but only 39% thought that current error reporting systems were adequate. Most pediatricians had used a formal error reporting mechanism, such as an incident report (65%), but many also used informal reporting mechanisms, such as telling a supervisor (47%) or senior physician (38%), and discussed errors with colleagues (72%). Respondents endorsed disclosing errors to patients' families (99%, serious; 90%, minor; 39%, near miss), and many had done so (36%, serious; 52%, minor). Residents were more likely than attending physicians to believe that disclosing a serious error would be difficult (96% vs 86%; P = .004) and to want disclosure training (69% vs 56%; P = .03).

Conclusions  Pediatricians are willing to report errors to hospitals and disclose errors to patients' families but believe current reporting systems are inadequate and struggle with error disclosure. Improving error reporting systems and encouraging physicians to report near misses, as well as providing training in error disclosure, could help prevent future errors and increase patient trust.

Author Affiliations: Department of Medicine, Washington University School of Medicine (Drs Garbutt, Waterman, Hazel, Dunagan, and Fraser and Ms Krauss) and the Center of Health-Care Quality and Effectiveness, BJC HealthCare (Dr Dunagan), St Louis, Mo; and Departments of Pediatrics (Drs Brownstein, Klein, and Marcuse) and General Internal Medicine (Dr Gallagher), University of Washington School of Medicine, Seattle.

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