When a serious adverse event occurs, sincere sympathy and compassion expressed to the patient and/or family is often the most important response to help diffuse a potentially volatile situation. Rather than taking a defensive stance against accusations of substandard care, the health care team should refrain from castigation or infighting and immediately begin the following positive measures:

Assess the situation and communicate with the patient and family

• Determine who from the health care team will discuss the event, with whom (the patient and/or responsible family member), and when.
• Achieve consensus among team members as to the factual details and sequence of what occurred and what needs to be done in response.
• Discuss how the details of the event, the outcome, and the treatment plan will be explained.
• Maintain contact with each other and the patient/family for questions. Repeated requests for an explanation of the event is a common reaction of angry or anxious patients and family members.
• Organize a family meeting if several relatives are involved in the patient's care or if treatment decisions are complicated.
• Contact the institutional risk manager and complete any institutional reporting requirements (potential claim, medical device failure, etc.) if indicated.
• Empathize with the patient and family; offer emotional support. If appropriate, apologize for the patient's distress,without admitting liability.
• Attempt to reconcile opposing perceptions of what has occurred.
• Accept responsibility for follow up of serious complaints, but do not accept or assign blame, or criticize the care or response of other providers.

The Medical Record

• Assign the most involved and knowledgeable staff member(s) to record factual statements of the event in the patient's record and any follow-up needed or done as a result of the incident.
• Avoid writing in the record any information unrelated to the care of the patient (e.g., "incident report filed," "legal office notified").