Medical Errors Disclosure Practices, Barriers and Motivations to Disclosures Among Physicians in Tertiary and Secondary Health Facilities in Abuja Nigeria

Abstract

The disclosure of medical errors is very important in ensuring the quality of patient care and safety. However, the disclosure practices by physicians are not well documented in this setting. The objective of this study is to compare the disclosure practices as well as the motivations and barriers to disclosure of these errors among physicians in government secondary and tertiary health facilities in Abuja, Nigeria. A cross sectional survey of physicians working in six out of fourteen government hospitals was conducted. A cluster sampling technique of the hospitals as the clusters was employed to obtain the total sample size of 402 physicians, 201 for each level. A semi structured, self-administered questionnaire was used to collect quantitative data on near misses, mistakes, slips or lapses and technical errors. Data was analysed using SPSS version 15.0 and summarised as proportions. Chi-square test was used to assess associations between variables at a significance level of 5%. Also logistic regression analyses were used to determine the significant predictors of medical error occurrences and disclosures. Some 255 physicians i.e. (52.6%) from the tertiary level and 230 (47.4%) from the secondary level were interviewed. Both the tertiary and the secondary levels had very poor medical errors disclosure practices, with disclosure of errors that caused patient’s death or disability (3.9 vs. 8.3%, p=0.023); or disclosure of errors that caused discomfort or prolonged treatment to patients (33.2% vs. 21.3%, p=0.026). The major barriers to error disclosures at the tertiary and the secondary health facilities were: lack of malpractice insurance (69.4% vs. 48.2%, p=0.000); lack of policies for disclosing errors (62.4% vs. 55.4%, p=0.119); and the fear of negative patient reactions (56.7% vs. 51.3%, p=0.233). The major motivations to errors disclosure were receiving a positive feedback from the institution (65.1% vs. 56.3%, p=0.048) and the support and understanding of colleagues (50.2% vs. 48.7%, p=0.74). This study suggests poor medical errors disclosure practices. In this study setting, the development of institutional policies on disclosure will motivate physicians’ disclosure of medical errors and this should be encouraged. Such policies should include institutionally administered malpractice insurance for the physicians.