Oregon’s Patient Safety Commission issued its first annual report on the Early Discussion and Resolution (EDR) of serious adverse events. This post hits the highlights.
What is it, again?
“Serious adverse event” is an “unanticipated consequence of patient care that is usually preventable and results in death or serious physical injury” that occurred on or after July 1, 2014. It includes medical, dental and other alleged medical mishaps and malpractice. The list of health care providers who may avail themselves of the process is long. (ORS 31.740(1))
EDR is a state-moderated process that seeks to encourage early disclosure and open communications between a patient and health care provider. Either may initiate the process with a notice. Communications are confidential and mostly privileged. There is a loophole for certain inconsistent statements that may, possibly, be plugged with foresight and a written agreement. The Oregon Patient Safety Commission (OPSC) maintains a list of trained mediators to assist the parties, which includes me. (Click this link for the law that established the EDR process.)
First Year Use: 29 Notices.
Patients initiated the process 21 times (72%) and health care providers filed eight notices (28%). Considering the start date of July 1, 2014, we assume the number of notices will increase as more procedures qualify and more people become aware of, and comfortable with, the process. Personally, I believe the number will balloon as we get into the summer of 2016, and people want to file notice to toll the statute of limitations.
Providers accepted 9 patient notices. We don’t have data on the number of provider notices accepted by patients.
12 rejected patient notices. Reasons? Already addressed another way (5 rejections). Not “serious adverse event” (5 rejections). Other reasons noted: advised to decline by insurer or attorney; settled before EDR could start; “known complication, and “provider not employed by facility. It appears that some providers noted more than one reason to reject EDR.
Rest of the report.
Oregon Patient Safety Commission’s report describes the EDR process and its outreach efforts. The report provides a good summary of the program and some of the issues.
Analyzing the use of EDR, OPSC notes some providers fear participation may increase liability risk or trigger reports to the National Practitioner Databank or state regulators. Other providers understand that offering patients a path to understand what happened other than complaining to a licensing board or through an attorney can benefit both patient and provider. “A conversation offering a full disclosure of what happened and an acknowledgment of the patient’s pain can prevent [complaints / lawsuits.]”
On the other side, many patients simply don’t know their options for non-lawyer resolutions, whether offered by the provider, through OPSC or other means. OPSC provided a list of where to report alleged violations of standards of care for different providers, from Acupuncturists to the V.A.
The report describes the overall goal of reducing harm to patients and distress to providers by creating a Culture of Safety. It sets forth and describes the three pillars of safety: Learning Culture, Just Culture and Reporting Culture. For anyone who wants that overview and how EDR fits into the Culture of Safety paradigm, I recommend the report.
Jeff Merrick, Mediator