Adverse Events Disclosure

Introduction

Health care professionals provide exceptional patient care to improve the quality of life for patients and their families. Despite clinical expertise and systems designed to ensure patients receive safe care in every encounter, adverse events and unexpected outcomes continue to reach patients.¹

When patients are injured by a clinician’s mistake or experience an unexpected outcome, they may feel hurt, betrayed, devalued and afraid. Communicating with patients after an adverse event, taking accountability and expressing empathy helps to restore the patient’s dignity, rebuild trust with the health care team and begin the healing process. It also helps the clinicians begin to deal with their own emotional response.²

Purpose

The following provides guidance to provide clinicians and teams with a structured, patient-centered approach for communication after an adverse event or unanticipated outcome. The goals of communication after a safety event are to rebuild or maintain trust and support patients and families through transparency.³

Note: Each organization must determine a clear policy/set of guidelines defining its threshold for an unanticipated outcome, adverse event, error, and the associated expectation for disclosure.

Don’t go alone! Contact your clinical leadership and patient safety team who can help you respond to an adverse event, prepare for the conversation and provide ongoing support for both the patient and care team.

What to Disclose

General principle: Unanticipated outcomes and medical errors when:

• You would want to know about the event if it had happened to you, a relative or loved one.
• It may result in a change in treatment, whether now or in the future.

Process

1. First Priority: Ensure Patient Safety:

• Ensure the clinical team stays fully attentive to the medical needs of the patient.
• Address immediate clinical needs and stabilize the patient.
• Develop a treatment plan and communicate the plan to the patient and/or their family.

2. Assess the formal or informal needs of the staff involved:

• Clinicians involved in an event can often become distressed and distracted, which can affect their ability to care for themselves and future patients.
• Be sure to offer formal and informal support to clinicians involved4.

3. Notify Key Individuals:

• Inform the attending physician, risk management, and relevant leadership.
• Many institutions have a 24/7 communication number/hotline available to help support clinicians with coaching if needed.
• Enter the event into the organization’s safety reporting system.

4. Team Debrief:

• Debrief with staff involved to gather the facts. Gathering information initiates the learning process and ensures the clinical needs of the patient are being met.
• Preserve any relevant evidence (equipment, medication, documentation).

5. Prepare for the Initial Conversation:

• Identify who should participate.
• Set an agenda.
• Agree on the core facts and anticipate questions.
• Choose a private, quiet and safe setting.

6. Initial conversation:

• The initial conversation should occur as soon as possible after the event is identified and the patient’s clinical needs are attended to.
• Acknowledge the event.
• Begin with empathy: We are so sorry that this has happened, I can’t imagine how hard this must be for you.
• Be truthful. Share known facts clearly and in plain language.
• Avoid medical terminology, jargon or abbreviations.
• Do not speculate. It is okay to say you don’t know and that you will get back to them when more is known.
• Avoid using phrases such as If there was an error…, I apologize for whatever happened…, These things happen to the best of people….
• Explain impact on the patient’s clinical course, immediate treatment needs and next steps.
• Elicit and allow time for questions.
• Outline next steps
• Impact on treatment course and plan
• Discuss plan for ongoing institution review of the safety event.
• Provide name and contact information for followup. E.g., patient relations specialist

7. Follow-Up:

• Partner with department leadership, patient safety and risk management to complete review of the event.
• Provide ongoing updates to the patient and family about the clinical event, and steps undertaken to prevent future events.
• Support patients/families and clinicians.

8. Documentation:

• Document clinical information relevant to patient care in the medical record.
• Do not place blame or speculate on what occurred in the medical record.
• Document that disclosure occurred but preserve the medical record for objective documentation of clinical care pertinent to the event.
• Do not document that a safety report was filed in the patient’s medical record.
• Do not disclose peer review materials.
• Do not go back into the record to alter charts/documentation or add addendums.
• Note all communication, including texts and emails, is subject to subpoena.

Key Takeaways

• Disclosure should be timely, honest, empathetic, and patient-centered.
• Using a team-based, prepared approach—disclosure should never occur in isolation.
• Do not abandon the patient. Providing regular follow-up and ongoing communication are essential to restoring trust.
• Both patients and providers require support after an adverse event.