Throughout the month of July, we have shared information on the organization’s Adverse Event Disclosure Program. The primary goal of this program is to afford providers practicing within Children’s enterprise support and resources to assist them with the disclosure of adverse events to patients and families. As the month of July comes to a close, we want to leave you with some final words of guidance from Bridget Norton, M.D., MBA, Pediatric Hospital Medicine, and Chief Quality & Safety Officer:
In my role as an ICU physician, I have had numerous disclosure conversations, and I have received questions from my peers regarding disclosure. These questions are most commonly related to whether or not an event needs to be disclosed and/or what should be included in the conversation. These are both really good questions because the answer isn’t always simple.
What events need to be disclosed?
That is not always an easy question to answer. When you are unsure if an event or situation needs to be disclosed, ask yourself, “What would a reasonable family want to know?” The list below is not meant to be exhaustive, but these guiding questions can provide direction on what events to disclose.
- Did this event result in a change in the treatment plan, now or in the future?
- Did the event require the patient to be placed in a higher level of care?
- Did the event result in a need for increased patient monitoring?
- Did the event result in the need for specialist consultation?
- Will the patient experience be impacted by this event?
- Will the event result in additional charges?
- Will the event result in an extended hospital stay?
Answering yes to any one question is not dispositive, but the more “yes” responses you have, the more likely it is you should disclose. All of this information can be found in the Disclosure Guiding Questions support document. Disclosure coaches are also available to discuss individual cases if you have questions.
What should this conversation include?
There is a big difference between a family being aware or present during rounds and an actual disclosure conversation taking place. A disclosure conversation is very purposeful and contains the following foundational elements:
- Expressions of empathy
- Description of what happened (details known to be factual at the time of the disclosure discussion)
- Description of patient’s current status
- Description of patient’s current health care needs
- Outline of next steps in patient’s care
- Description of the potential adverse event consequences now and in the future
- Assurance of further review of the adverse event and follow-up discussion(s) with the family, if appropriate
- Documentation of the conversation using the “.disclosure” note template.
All of this information, along with additional tips and specific phrases, can be found in the Disclosure Conversation Guide support document. I encourage you to set yourself up for success by utilizing all the disclosure resources available to you. Click here to visit the Disclosure Page on MyChildren’s.