Background: Medical errors and adverse events are leading causes of morbidity and mortality in the United States. Reporting errors – both those that do and do not cause harm to patients – is paramount to preventing recurrences within the medical system and, therefore, reducing future harm. However, physicians may be reluctant to disclose errors due to litigation risks, the stigma around adverse events, and a workplace that does not promote safety and just culture. Even when errors are reported and disclosed, many physicians lack the skills for empathetic disclosure, harm resolution, and event investigation. As a result, patients and families, as well as caregivers, are left with inadequate support through an already challenging time. The Communications And Optimal Resolution (CANDOR) program, which is supported by the Agency for Healthcare Quality and Research, is a comprehensive approach on responding to unexpected adverse events and preventing future harm. However, using CANDOR to address provider knowledge gaps has been complicated by the time-intensive training process and COVID-19 pandemic restrictions on group gatherings.
Purpose: To create a sustainable CANDOR program to improve patient, family and clinician experiences, promote early reporting and investigation of adverse events, and ultimately reduce liability and patient harm.
Description: A multi-disciplinary team developed a webinar-based training curriculum for medical trainees, designed for easy modification by other University of California (UC) sites and beyond. The curriculum includes five recorded presentations that use impactful stories and adverse event disclosures to discuss 1) teamwork and communication, 2) adverse event disclosure and apology, 3) event reporting and investigation, 4) a Just Culture and care for caregivers, and 5) time out and consent processes. All topics are mandated for medical students during their final pre-graduation classwork and will be required for resident and fellow physicians during their subsequent training. These lectures will also be supplemented by facilitated videoconference discussions for interested trainee programs.
Conclusions: Error reporting, event investigation, and caregiver support are crucial for reducing adverse events and malpractice risk exposure. Lack of formal education in these topics, the time-intensive demand on the educator, and scheduling difficulties are notable barriers. We aim to overcome these barriers through the development of a new CANDOR webinar curriculum. With the implementation of this program, we anticipate that there will be greater transparency in the hospital and, as a result, improvement in patient safety. Future steps include 1) dissemination to other UC sites and other interested programs, 2) adapting the curriculum for other healthcare workers including nurses and pharmacists, and 3) assessing trainee knowledge with pre- and post-training surveys.