Disclosing errors and adverse events in the intensive care unit.

OBJECTIVE: To review the issue of disclosing errors in care and adverse events that have caused harm to patients in critical care.

DESIGN: Review the scope of the problem, the definitions of errors and adverse events, and the benefits and problems of disclosing errors and adverse events and provide an approach by which to have these difficult discussions.

SETTING: Medical center.

PATIENTS: Critically ill patients and their families.

INTERVENTIONS: Applying a systematic framework for disclosing errors and adverse events to affected patients and their families.

MEASUREMENTS AND MAIN RESULTS: Several national organizations mandate that physicians discuss errors in care and adverse events that have caused harm with affected patients, but failure to do so is a common problem in critical care as surveys of intensivists indicate that, although most believe that errors should be disclosed, few routinely do so. The likelihood of an adverse event is increased in intensive care units because of the nature of critical care. Not all errors or adverse events require disclosure. There are ethical, financial, legal, systems, and personal benefits to disclosing errors, and disclosure discussions should address common patient concerns.

CONCLUSIONS: Failure to disclose errors and adverse events in critical care is an important and common problem. There are numerous reasons why errors and adverse events should be disclosed, and use of a standard framework for doing so will facilitate the process.