Intersystem Medical Error Discovery in Otolaryngology-Head and Neck Surgery.

Abstract

Importance: Intersystem medical error discovery (IMED) involves clinicians identifying errors that occurred outside of their facility while a patient was under another clinician's care. Despite its major implications for safety and quality of care, explicit guidance is limited. Given the complexity of disorders and specialization within otolaryngology, IMED is a considerable concern, yet little is known about current practices or management strategies.

Objective: To explore otolaryngologists' perceptions and practices around feedback and reporting of IMED and to identify strategies for preventing or responding to these errors.

Design, setting, and participants: This qualitative study used semistructured, virtual interviews of 24 otolaryngologists with expertise in patient safety and quality improvement across the US from July to October of 2023. Purposive sampling ensured diversity in subspecialty, career stage, geography, practice context, and demographics.

Main outcomes and measures: Otolaryngologist perceptions of IMED, encompassing barriers and facilitators to providing feedback or reporting IMED, and strategies for improving practices. Analysis followed an iterative inductive approach of interpretive description.

Results: Among the 24 participants (median [IQR] age, 51 [43-59] years; 13 [54%] female), several barriers, facilitators, and strategies emerged. Barriers included logistical (eg, lack of proximity, unavailable contact information, time constraints), psychosocial (eg, interpersonal discomfort, fear of retaliation, burnout), and structural factors (eg, fragmented systems, lack of incentives, leadership modeling, perceived conflict of interest). Facilitators that were associated with increased feedback or reporting included severe, egregious, fraudulent, or repetitive errors and preexisting relationships with the involved clinician. Most participants believed that IMED was inadequately addressed, with proposed strategies encompassing feedback training, standardized guidelines, interoperable medical records, oversight by national or state bodies, and intersystem safety reporting mechanisms.

Conclusions and relevance: This qualitative study shows that the absence of standardized processes and resources hampers effective responses to IMED, such as feedback and reporting. While egregious errors or preexisting relationships may trigger action, opportunities exist to enhance clinical practice and policies across health systems.