1. Disclosing Adverse Clinical Events to Patients and Families Fundamental Elements

2. Why should we disclose? Patients have the Right to Know
To improve Physician/ Patient Relationship - Trust
To improve patient care and prevent future occurrences.
Professional ethics
Reduced liability costs (University of Michigan Disclosure Program)
Required by the NJ Department of Health

3. Barriers to Disclosure
Fear of Liability
Concern about Patient and family response
Lack of comfort with the process

4. Triggers for disclosure
A serious preventable adverse event that results in:
An unintended injury or illness
Death
Loss of a body part
Disability
Loss of bodily function lasting more than seven days or still present at the time of discharge from a health care facility.
An adverse effect resulting from an allergic reaction not previously documented in the patient’s medical history

5. Cooper Policy and Procedures/NJ State Law Regarding Disclosure
Requires responsible licensed independent practitioner/designee within 24 hours of discovery to:
Disclose the event
Apologize honestly and openly to the patient (and/or family) and answer their questions
Provide the patient and/or family all information needed for current and future healthcare decisions
Record in the chart that the disclosure was made, the date and time it was made, who it was made to, and the individuals present at the disclosure. This is not subject to discovery or for use in litigation (N.J. Admin. Code § 8:43E-10.9)
Adverse Clinical Events Policy #1.216

6. The Other 4 “W’s” of Disclosure
Who should disclose (may be one or more of the following)
Healthcare provider(s) involved in the unanticipated outcome
Provider(s) with responsibility for ongoing care
Person(s) with ability to answer questions (Medical Director or Administrator)
What to disclose
The nature of the event, consequences for the patient, and what is being done to correct it
When to disclose
After immediate health care needs are addressed
Within 24 hours of discovery of the event
Patient is physically and emotionally ready and gives permission to discuss with family if applicable
Where to disclose
Consider privacy and patient’s current health needs, comfortable seating and limit number of people.

7. How to Disclose
Use a short, concise message with a simple description of current condition and the next steps in the patient’s medical care treatment options. Focus on the patient’s and family’s needs
Apologize-- Express empathy and compassion for pain
“I’m sorry that you and your family have experienced this event”
Responsibility – provide objective information – no blame
Elicit questions or concerns and ensure understanding
Ask if they have any questions or if they need anything at this time.
Plan the next step/next contact and close discussion
Provide name of a contact person

8. Questions