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Effective Disclosure: Steps for Successful Communication
Suggested Reading 1
Christopher Conley Kendall Jenkins Shiloh Dawson
Bates, D. W., Levine, D. M., Salmasian, H., Syrowatka, A., Shahian, D. M., Lipsitz, S., et al (2023). The safety of inpatient health care. New England Journal of Medicine, 388(2), 142–153. https:// doi.org/10.1056/nejmsa2206117 2 Cooper, J. B., Cullen, D. J., Eichhorn, J. H., Philip, J. H., & Holzman, R. S. (1993). Administrative guidelines for response to an adverse anesthesia event. Journal of Clinical Anesthesia, 5(1), 79–84. https://doi. org/10.1016/0952-8180(93)90095-v 3 Gaba, D. M. (2021). What to do after an adverse event. Anesthesia Patient Safety Foundation. Retrieved June 7, 2023 from https:// www.apsf.org/article/what-to-do- after-an-adverse-event/ 4 Klein, J. W., Jackson, S. L., Bell, S. K., Anselmo, M. K., Walker, J., Delbanco, T., & Elmore, J. G. (2016a). Your patient is now reading your note: Opportunities, problems, and prospects. The American Journal of Medicine, 129(10), 1018– 1021. https://doi.org/10.1016/j. amjmed.2016.05.015 5 Rafter, N., Hickey, A., Condell, S., Conroy, R., O’Connor, P., Vaughan, D., & Williams, D. (2014). Adverse events in healthcare: Learning from mistakes. QJM, 108(4), 273–277. https://doi.org/10.1093/qjmed/ hcu145 6 U.S. Department of Health and Human Services, Office of Inspector General. (2010). Adverse events in hospitals: National incidence among Medicare beneficiaries (OEI Report No. 06-09-00090). Retrieved June 7, 2023 from https://oig.hhs. gov/oei/reports/oei-06-09-00090. pdf
Learning Objectives 1. Understand the importance of timely disclosure of adverse events. 2. Acknowledge who should receive the disclosure and the appropriate information to disclose. 3. Identify the steps required to plan and conduct an effective disclosure.
Introduction Disclosure after an adverse event is an intricate process with numerous challenges. Patients typically do not anticipate complications when undergoing medical procedures, despite participating in the informed consent process. Healthcare providers, guided by the principle of “first, do no harm,” prioritize safe care and positive patient outcomes. However, when unexpected adverse events occur, they can be emotionally charged and present unique challenges for everyone involved. In this case, effective communication becomes vital, necessitating careful consideration of when, how, and with whom to disclose the information pertaining to the event. This chapter explores the complexities of disclosure, including timing, execution, and communication strategies, as well as the importance of systematization, education, and training in facilitating improved patient and family experiences in the aftermath of adverse events. Why is disclosure after an adverse event so challenging? Even after participating in the informed consent process, patients rarely anticipate experiencing complications themselves when undergoing a care plan or procedure. On the provider side,
guided by the principle of primum non nocere (first, do no harm), physicians and caregivers naturally prioritize patient safety and seek to follow care pathways that minimize risks and maximize positive outcomes. Consequently, when an unexpected and often sudden adverse event occurs, it can be unsettling for everyone involved. As such, it becomes crucial to be intentional about the timing, manner, and recipients of communication in the aftermath of a setback or unanticipated injury. Timeline In the setting of a crisis or injury, our primary responsibility is to the patient. If the event is ongoing, it may be necessary to communicate with the patient or their family while simultaneously managing and mitigating the adverse event. When the patient is conscious, oriented, and capable of interaction, disclosure of errors or complications should take place in real- time as they are being addressed and treated. However, the timing and manner of communication and disclosure become complex when dealing with unresponsive or non-interacting patients, such as those under sedation or anesthesia. In such cases, if sufficient personnel are available, a designated member of the crisis response team may reach out to the family. Their role would involve informing them
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WHAT DID YOU SAY?
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