The 'seven pillars' response to patient safety incidents: effects on medical liability processes and outcomes

Objective. To determine whether a communication and resolution approach to patient harm is associated with changes in medical liability processes and outcomes. Data Sources/Study Setting. Administrative, safety, and risk management data from the University of Illinois Hospital and Health Sciences System, from 2002 to 2014. Study Design. Single health system, interrupted time series design. Using Mann-Whitney Utests and segmented regression models, we compared means and trends in incident reports, claims, event analyses, patient communication consults, legal fees, costs per claim, settlements, and self-insurance expenses before and after the implementation of the 'Seven Pillars' communication and resolution intervention. Data Collection Methods. Queried databases maintained by Department of Safety and Risk Management and the Department of Administrative Services at UIH. Extracted data from risk module of the Midas incident reporting system. Principal Findings. The intervention nearly doubled the number of incident reports, halved the number of claims, and reduced legal fees and costs as well as total costs per claim, settlement amounts, and self-insurance costs. Conclusions. A communication and optimal resolution (CANDOR) approach to adverse events was associated with long-lasting, clinically and financially significant changes in a large set of core medical liability process and outcome measures. Key Words. Patient safety, medical liability, disclosure, communication, resolution
Improving patient safety and minimizing medical liability costs are important priorities for U.S. health care system reform (Kohn, Corrigan, and Donaldson 2000; Clinton and Obama 2006; Leape et al. 2009; [...]