BWH Policy for Disclosure of Adverse Patient Events
When patients come to the hospital for care, they have certain expectations about how their experience will be. Most, if not all, expect that, for instance, the surgery will go as planned; the complications that were discussed by the surgeon in the office will never materialize; the patient will receive the appropriate medication and that he or she will be discharged from the hospital sooner than anticipated. Because positive outcomes usually do result, it is often difficult for BWH clinicians to communicate why things haven’t gone as planned to the patient and his or her family.
It is well recognized that clinicians have a legal and ethical obligation to disclose adverse events to patients and/or family members. In July 2001, the Joint Commission for Accreditation of Healthcare Organizations (JCAHO) promulgated new patient safety standards, one of which mandates that health care organizations have a practice for ensuring that patients and/or their family members are informed about outcomes of care, especially those outcomes that differ significantly from what was originally anticipated.
BWH recognizes that timely, complete and open communication between the clinician and the patient serves to strengthen the professional relationship and fosters patients’ trust in the health care system, even when things don’t occur as planned in the care setting. The recently drafted BWH policy “Guidelines for Disclosure of Information Related to Adverse Patient Events” has been designed to provide guidance to the clinician in those situations that, either as a result of medical error or other cause, the patient has been harmed. The practical issues of disclosure, including whether to disclose, who should disclose, timing and what to say are addressed in the policy. The Risk Management Department is available as a resource when questions arise about the appropriateness of the discussion, involved parties, timing or consideration of financial reimbursement. In addition, the Ethics Service, Administrator-On-Call and Nursing Administrator are also available to provide support. The policy can be accessed through the Hospital Administrative Policy Manual, Policy V-18a.
Questions about the policy, disclosure generally or other related patient safety issues should be addressed with the Risk Management Department or the Patient Safety Team. Contact Janet Barnes, Tejal Gandhi, MD, or Erin Graydon-Baker via e-mail.