AAOS Now

Published 8/1/2012
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Darren Bouwmeester, JD

Responding Effectively to Adverse Events

The REACT approach to disclosure and apology

Sharing bad news is never easy. And although most physicians understand that it’s the right thing to do, disclosing an adverse medical event to a patient can be especially difficult. However, when an adverse event occurs, patients want to understand what happened and why, and they expect open communication, honesty, and empathy from their providers. For patients, professional competence in health care isn’t just about clinical skill, it’s also about integrity and caring.

REACT program
Developed by Coverys (formerly ProMutual Group), the Respond Effectively And Communicate Timely (REACT®) program is designed to help policyholders successfully navigate the disclosure and apology process with their patients. Specifically, the goals of the REACT program are as follows:

  • To encourage empathy and effectuate communication between providers and their patients
  • To advise providers concerning disclosure, and apology, if appropriate
  • To support the continuation of the provider–patient relationship
  • To help address patient needs following an adverse event
  • To reduce the need for litigation

A key element of the voluntary REACT program is its early-intervention requirement. Policyholders enrolled in the program must report an adverse event to the REACT program administrator within 30 days of when he or she becomes aware of an adverse event.

“One of the most important ways providers can mitigate their risk is by responding in a timely manner to their patient’s needs, which includes timely disclosure,” said Barbara Staples, Coverys director of claims. “When patients feel that their provider is unresponsive to their needs or is not being forthcoming, the unfortunate result is oftentimes a lawsuit. In encouraging a timely response through the REACT program, we are trying to help our policyholders maintain a positive relationship with their patients.”

With REACT, policyholders can consult with the program administrator before discussing the adverse event with a patient or family. This is particularly helpful for providers who do not have the support of a risk manager in their practice. However, if an adverse event takes place in a hospital, the provider must work in partnership with the risk management services at the facility while following the facility’s existing disclosure policy. In these circumstances it is not uncommon for a number of providers to be involved in the patient’s care, which underscores the importance of coordinating the disclosure to avoid any confusion or misunderstandings.

Program benefits
When an adverse event qualifies for the REACT program, the patient may be eligible for reimbursement of up to $25,000 for out-of-pocket expenses not covered by existing health insurance. Typical out-of-pocket expenses eligible for reimbursement include copayments, deductibles, prescriptions, childcare, and transportation. Patients experiencing an adverse event may also be eligible for up to $5,000 for loss of time, paid as a $100 per day stipend for each day that the patient is incapacitated as a result of the adverse event.

The REACT program also provides its participants with educational benefits. In addition to providing in-person educational programs on disclosure to hospitals and physician groups, the REACT program, in conjunction with the University of Massachusetts Medical School’s Center for Clinical Communication and Performance Outcomes, has developed an online educational program in disclosure, which will be available in 2013 on Coverys’ continuing medical education (CME) website. This online program will offer physicians a timely resource, additional convenience, and the opportunity to deepen their understanding and proficiency in disclosure and apology.

Now in its third year, the REACT pilot program is available in Connecticut, Maine, Maryland, Massachusetts, New Hampshire, North Carolina, Vermont, and Virginia. Response to the program from policyholders and patients has been positive. Providers appreciate having additional resources at their disposal, including the ability to consult with someone about the disclosure and to offer monetary resources to their patient. Patients appreciate their providers for being upfront and attentive to their needs and the REACT program for providing them with assistance during a difficult time.

Not all adverse events are eligible for the REACT program. For example, events involving either serious injury or death and those in which the patient has retained an attorney or already decided to take legal or board action against the provider are ineligible. Insured healthcare providers who are interested in participating in the REACT program or who have a patient who has experienced an adverse event while in their care should contact the REACT program administrator.

Darren Bouwmeester, JD, is the REACT program administrator. He can be reached at DBouwmeester@coverys.com

Disclosure Dos and Don’ts:
Do:

  • Initiate the disclosure process as soon as possible after an adverse event.
  • Express empathy with the patient or family and sympathy for any pain and suffering.
  • Be prepared to listen to the patient and/or family.
  • Document the adverse event succinctly and factually in the patient record.

Don’t

  • Lie or cover up. Patients want honesty and are more willing to forgive an error than a lie.
  • Blame someone else. Blaming someone else is an almost certain way of implicating oneself.
  • Be defensive. Try to meet anger with professionalism and objectivity.
  • Use medical jargon.

    (Excerpted from the REACT Disclosure Guidelines)

More about REACT
From inception through March 2012:

  • 107 adverse events have been accepted into the REACT program
  • More than $255,544 has been paid to patients under REACT
  • More than 75 REACT files have been closed
  • Only three of the cases taken into the REACT program have resulted in claims
  • REACT events involving orthopaedic care include the following:
  • Complications following casting of a fracture
  • Additional surgery following treatment of a fracture
  • Postoperative infections
  • Complications requiring readmission following surgery

Editor’s Note: Articles labeled Orthopaedic Risk Manager are presented by the Medical Liability Committee under the direction of contributing editor David H. Sohn, JD, MD.

Articles are provided for general information and are not legal advice; for legal advice, consult a qualified professional.

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