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EARLY DISCUSSION AND
RESOLUTION
Bethany Walmsley
Bud Pierce
Melissa Parkerton
Mark Bonanno
Bethany Walmsley, Executive Director, Oregon Patient Safety Commission
THE COMMISSION’S COMMITMENT TO
SHARED LEARNING
Oregon Patient Safety Commission
Improve patient safety by reducing the risk of serious
adverse events occurring in Oregon’s healthcare system and
by encouraging a culture of patient safety (§442.820).
Quality Improvement
and Disseminating
Best Practices
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Early Discussion
and Resolution
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Patient Safety
Reporting Program
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Patient Safety Reporting Program
A confidential and voluntary program for healthcare
facilities to report adverse event investigation findings
and action plans
• Understand why and how adverse events occur
• Share aggregate information to improve healthcare
in Oregon
• Identify and share evidence-based prevention practices to
improve patient outcomes
• Promote quality improvement by convening statewide groups
to address serious patient safety issues and providing
educational programs in patient safety and quality
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Bud Pierce, MD
Co-Chair, Task Force on Resolution of Adverse Healthcare Incidents
TRANSPARENCY FOR PATIENT SAFETY
Honest, Proactive Communication
• It’s the right thing for patients
• It’s the right thing for providers
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Strategies for Disclosure
A case study
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Melissa Parkerton, Director, Early Discussion and Resolution
EARLY DISCUSSION AND RESOLUTION (EDR)
OVERVIEW AND STATUS
EDR Overview
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EDR Status
• 22 notices received*
• 32% filed by facilities
• 68% filed by patients
• Consultation provided by phone and email
• Presentations provided to associations, boards,
facilities, and community groups
• Peer Support Development Program attended by
65 participants
• First annual report to be published in the fall
*As of April 24, 2015
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Participation Tips
• If you work at a healthcare facility*, make sure an EDR
Manager has been designated
• If you do not work at a healthcare facility, designate
someone within your organization to manage EDR notices
and notify the Commission
• Consider putting a clear policy in place that integrates EDR
into current practices
• Educate your healthcare providers about EDR and how
you can support them so they aren’t scared when named
in a notice
*Hospital, ASC, nursing facility, dialysis facility, or birthing center
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Participation Tips
• Respond quickly when patients file notices
even if you do not intend to participate
• Develop a peer support program
• Consider in-house disclosure training
• Call the Commission for help with any
concerns or questions
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Learn More
edr.oregonpatientsafety.org
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Provider Resources
Mark A. Bonanno, JD MPH
General Counsel and Director of Health Policy
Oregon Medical Association
THE LEGAL GRAY AREAS OF EDR
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Confidentiality
The issue: EDR statute only protects “discussion communication”
made in the course of discussion of an adverse health care
incident, and there will be procedural questions about timing of
discussions, materials prepared for and the content of discussions,
and subsequent challenges to the protections.
What you should know: During the EDR process, written or oral
communications made in the course of EDR discussions are: not an
admission of liability, not admissible, and confidential. Be careful
with contradictory statements, material prepared before or after
the statutory process, and discussions before or after the process.
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Reporting: Databank
The issue: Payments by carriers in medical malpractice cases
generally are reported to the National Practitioner Databank
(NPDB), and EDR raised some legitimate questions about
reporting.
What should you know: The April 2015 NPDB Guidebook
provides (clearer) guidance
http://www.npdb.hrsa.gov/resources/aboutGuidebooks.jsp
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Reporting: Databank
NPDB Guidebook Chapter E
8. Following an unsuccessful course of treatment, a patient and a practitioner
enter into a State-sponsored voluntary series of discussions in an attempt to
settle their disagreement before resorting to litigation. The discussions lead to
the practitioner’s insurance company making a money payment to the patient
to settle the dispute. Should this money payment be reported to the NPDB?
“It depends. If, during the course of discussions, the patient made a written
complaint or written claim demanding a monetary payment for damages, the
payment must be reported. If the complaint or claim for damages was never put
in writing, the payment is not reportable.”
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Reporting: Medical Board
The issue: In addition to federal reporting questions, state
licensing board questions have been raised too. For example,
medical boards generally ask questions about settlements of
claims or potential claims in their standard renewal
questionnaires for licensees.
What you should know: The EDR statute does restrict a
licensing board from asking a provider about an EDR notice
or using the fact a notice was filed as the basis for
disciplinary action.
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Reporting: Medical Board
EDR Statutory Language
“A regulatory agency, licensing board, healthcare facility,
health insurer or credentialing entity may not ask the
Commission, a healthcare facility, a healthcare provider or
other person whether a facility or provider has filed a notice
of adverse health care incident or use the fact that a notice
of adverse health care incident was filed as the basis of
disciplinary, regulatory, licensure or credentialing action.”
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Communication
The issue: Providers raise questions about how to engage in
EDR discussions because they have been trained to disclose
very little to patients or are uncomfortable with the difficult
conversations involving disclosures.
What you should know: EDR mostly is about effective
communication between providers and patients. Providers
need to learn to be fact-based in discussions, respectful and
sincere in their demeanor, and do more listening to rather
than talking to patients.
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Reform Landscape
The issue: EDR raises general questions about medical
malpractice reform and whether it is the right vehicle for
reform.
What you should know: EDR is one tool in the toolbox that
addresses patient death or serious injury in a respectful
manner, and if conducted effectively, can reduce liability
exposure and costs in both time and money to bring matters
to meaningful closure.
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OMA Resources
• OMA Website resources
http://www.theoma.org/node/3807
• OMA Medical-Legal Compliance Team
Contact Mark Bonanno or Danielle Sobel at (503)
619-8000
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Learn More
Oregon Patient Safety Commission
edr.oregonpatientsafety.org
edr@oregonpatientsafety.org
503-928-6158
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