Case Outcomes in a Communication-and-Resolution Program in New York Hospitals

Objective. To determine case outcomes in a communication-and-resolution program (CRP) implemented to respond to adverse events in general surgery. Study Setting. Five acute-care hospitals in New York City. Study Design. Following CRP implementation, hospitals recorded information about each CRP event for 22 months. Data Collection Methods. Risk managers prospectively collected data in collaboration with representatives from the hospital's insurer. External researchers administered an online satisfaction survey to clinicians involved in CRP events. Principal Findings. Among 125 CRP cases, disclosure conversations were carried out in 92 percent, explanations were conveyed in 88 percent, and apologies were offered in 72.8 percent. Three quarters of events did not involve substandard care. Compensation offers beyond bill waivers were deemed appropriate in 9 of 30 of cases in which substandard care caused harm and communicated in six such cases. In 44 percent of cases, hospitals identified steps that could be taken to improve safety. Clinicians had low awareness of the workings of the CRP, but high satisfaction with their experiences. Conclusions. The bulk of CRPs' work is in investigating and communicating about events not caused by substandard care. These CRPs were quite successful in handling such events, but less consistent in offering compensation in cases involving substandard care.