Disclosure of Adverse Events to Patients

Disclosure of adverse events to patients and families is both an ethical obligation and a quality improvement practice. Historically, many healthcare organizations discouraged open communication about errors, but the shift toward transparency has been supported by accreditation standards, ethical principles, and evidence showing benefits for both patients and organizations. CPHQ candidates should understand the principles and practices of effective disclosure.

Ethical and Regulatory Foundations

The duty to disclose adverse events is grounded in the ethical principles of autonomy (patients have a right to information about their care), beneficence (disclosure supports informed decision-making), and honesty. The Joint Commission requires that patients be informed about outcomes of care, including unanticipated outcomes. Many states have enacted disclosure laws, some of which include "apology laws" that protect expressions of sympathy from being used as evidence of liability in litigation. CMS Conditions of Participation also require that patients be informed about their care outcomes.

What Should Be Disclosed

Disclosure should include a description of what happened in terms the patient can understand, an acknowledgment that the outcome was not what was expected, an expression of empathy and apology, an explanation of what will be done to address the immediate situation, a description of what the organization is doing to prevent similar events, and a point of contact for ongoing questions. Disclosure should not include speculation, blame of specific individuals, or discussion of potential legal implications.

The Disclosure Conversation

Disclosure should occur as soon as possible after the event, in a private and comfortable setting. The conversation should be led by the attending physician or a trained disclosure team. Key principles include using plain language, allowing time for questions and emotional responses, avoiding medical jargon, documenting the conversation in the medical record, and following up as needed. Some organizations use trained disclosure coaches to support clinicians through these difficult conversations.

Communication and Resolution Programs

Some organizations have adopted Communication and Resolution Programs (CRPs) that combine early disclosure, investigation, and, when appropriate, proactive offers of compensation. Research on CRPs has shown that transparent communication can reduce litigation costs, improve patient satisfaction with the resolution process, and maintain trust. The AHRQ's CANDOR (Communication and Optimal Resolution) toolkit provides a structured framework for implementing these programs.

Challenges and Best Practices

Common barriers to effective disclosure include fear of litigation, lack of training, emotional distress of the involved clinicians, and organizational culture that discourages transparency. Best practices include developing a clear disclosure policy, training clinicians in communication skills, providing emotional support for disclosing providers, involving risk management early in the process, and creating a culture where transparency is valued as a component of quality care.