What should a disclosure include? Accuracy and honesty are of utmost importance in these circumstances, relying on facts rather than guesses. While describing the event and providing your assessment of the patient’s condition, maintaining accuracy is paramount. It is acceptable to acknowledge when information is not yet known, as “We don’t yet know” is a powerful and valid statement in the immediate aftermath of an emergency. Be mindful of the family’s tendency to cling to hope, so it is advisable to temper optimism with caution. Ensure that you share the plan for moving forward with the family. Reassure them that the healthcare team is diligently providing compassionate care to the patient, allowing you to step away from the bedside to keep them informed. Answer any questions they have to the best of your ability and outline the next steps in the care process. This should include informing them about when they can expect the next contact from the team regarding the patient’s progress and when they will be able to see and interact with the patient again. Patient relations can provide valuable assistance with this continuity planning. Expressing sorrow for what has happened is not an admission of guilt. It is perfectly acceptable to show care and empathy, and even to share in the family’s emotions. However, remember that in this moment, the focus should be on the family’s experience and not on our own. Their needs and emotions should take center stage. Systematization and Education Despite the numerous benefits that effective adverse event (AE) disclosures bring to clinicians, patients, and their families, there are still significant barriers that hinder their success. These barriers include a lack of role modeling and coaching, as well as limited opportunities for training and simulating best practices. As a result, clinicians often find themselves learning this skill in real-time, having to deliver news of an adverse outcome to patients or family members without adequate preparation. Understandably, providers report varying levels of knowledge and skill in conducting these discussions.
about the complication or sudden decline in the patient’s condition and, when appropriate, reconfirming the patient’s goals of care. This approach can be particularly beneficial for patients with advanced disease states who are undergoing intensive life-sustaining measures, such as ACLS (Advanced Cardiovascular Life Support). After stabilizing the situation and the patient, and once it is safe to be relieved from clinical duties, the designated team member should prioritize communication with the patient’s family or loved ones. During these moments, the department should also provide support to its healthcare providers. The providers directly involved in the event should be excused from clinical assignments as soon as it is feasible. Subsequent cases that were scheduled should either be postponed or managed by a separate team to ensure appropriate attention and focus. Disclosure conversations themselves can be incredibly challenging. It is essential to take a moment to gather oneself, compose emotions, and change into fresh scrubs if they have become soiled. Recognize the conversation that is about to take place will leave a lasting impression on the family involved. In preparation for the discussion, it is advisable to involve your hospital’s patient relations team early on. If possible, engage them during the management of the event. They possess valuable expertise and can offer tremendous support during these difficult moments. They can assist in finding a suitable, quiet conference room for the conversation and
provide resources to aid the family in coping with the situation, no matter how big or small. Whenever possible, consider bringing a senior and experienced colleague with you to the conversation. Their presence can help address challenging questions and provide additional support if you find yourself stumbling or feeling overwhelmed. Having their guidance can be invaluable in navigating the complexities of the discussion. Who should receive the disclosure? Under the guidelines of the Health Insurance Portability and Accountability Act (HIPAA), the U.S. Department of Health & Human Services allows for the disclosure of personal health information (PHI) in certain circumstances: “A covered entity is permitted to share (PHI) with a family member or other person involved in an individual’s care or payment for care as long as the individual does not object. In cases where the individual is incapacitated, a covered entity may share the individual’s information with the family member or other person if the covered entity determines, based on professional judgment, that the disclosure is in the best interest of the individual. If the individual is deceased, a covered entity may make the disclosure unless doing so is inconsistent with any prior expressed preference of the individual. These disclosures are generally limited to the health information that is relevant to the person’s involvement in the individual’s care or payment for care.” To establish a clear communication chain in the event of a complication where the patient is unable to participate, it is beneficial to have preprocedural discussions with patients. These discussions can address topics such as who can be contacted with updates or, even better, the patient’s designation of a healthcare proxy. By doing so, the communication process becomes more transparent, ensuring that the appropriate individuals are informed and involved if complications arise.
The absence of experiential training and a structured plan for disclosing adverse events not only adds to the stress of an already emotionally charged conversation but also increases the risk of miscommunication and a breakdown in trust between the care provider, the patient, and the patient’s family. Conversely, by implementing systematic disclosure policies, providing comprehensive training, and establishing standardized procedures for adverse event disclosure, healthcare departments can cultivate higher-quality communication with patients and families during these crucial discussions. Such an approach enhances the likelihood of successful and meaningful interactions, promoting trust and maintaining the integrity of the provider-patient relationship. Healthcare organizations are actively developing training, education programs, and cognitive aids to improve communication following adverse outcomes. The Agency for Healthcare Research and Quality provides training materials and tools through their “Communication and Optimal Resolution” course. Similarly, Children’s Hospitals’ Solutions for Patient Safety (SPS) offers a comprehensive guide, training curriculum, and various resources, including lectures, discussions, videos, and simulations for participants to practice their communication skills. To ensure ongoing competence, the SPS recommends annual retraining for physicians in this area. They also emphasize “just-in-time” abbreviated training, which offers a concise review of A colleague reminds another that the primary focus should be on patient care, urging them not to let communication requirements overshadow their responsibilities.
Effective communication can be the deciding factor between a favorable or unfavorable outcome in a crisis
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WHAT DID YOU SAY?
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