Disclosure

Facilitator's Guide and Outline

Rationale

Disclosure is driven by ethical, regulatory and patient-centered forces.

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Grabber

Providers who follow the proper procedure for disclosing a medical error to a harmed patient are less likely to be sued for malpractice than providers who neglect such disclosure.

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Key Message #1

Error disclosure is a policy, not a choice

  • Definition
  • Ethics
  • Regulatory requirements
  • The patient’s right to know

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Key Message #2

Your institution’s disclosure policy and procedure

  • Who’s responsible
  • Who needs to be notified
  • What (if anything) is written
  • What’s practiced
  • What’s causing any discrepancy between policy and practice

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Key Message #3

Disclosure a difficult process

  • Sadness/fear/embarrassment
  • Legal/malpractice ramifications
  • Unfamiliar process
  • Individual culture/experience

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Key Message #4

What events need to be disclosed

  • When a patient is harmed
  • When a patient is not harmed
  • When disclosure may do more harm than good

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Key Message #5

How disclosure is conducted

  • Who
  • What
  • When
  • How
  • Empathy and Apology
  • Documentation
  • Follow-up

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Key Message #6

The second victim

  • Senior physicians (attendings)
  • Residents and Fellows
  • Nurses
  • Other caregivers

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Key Message #7

Developing and practicing disclosure proficiency

  • Develop and document a process for patient focused disclosure (Exercise #1)
  • Practice
  • Increase your range of techniques

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Summary

Done right, disclosure can reduce an error's impact on the patient and the provider.

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