Disclosure After Adverse Events

Disclosure of adverse events to patients and families is both an ethical obligation and a quality imperative. Transparency after harm builds trust, supports healing, and can reduce litigation. CPHQ candidates should understand the principles, processes, and organizational supports necessary for effective disclosure.

Ethical and Regulatory Foundation

Multiple organizations endorse disclosure after adverse events. The Joint Commission requires that patients be informed about outcomes of care, including unanticipated outcomes. The National Quality Forum includes transparency and disclosure in its Safe Practices. Many state laws require disclosure of serious adverse events. The ethical principles of autonomy, beneficence, and justice all support honest communication with patients about their care.

Types of Disclosure

Disclosure may involve different levels depending on the severity of the event. Initial disclosure occurs soon after the event and includes acknowledging what happened, expressing empathy, and explaining what is being done for the patient. Follow-up disclosure occurs after investigation and may include additional information about contributing factors and steps taken to prevent recurrence.

Communication and Resolution Programs

Some organizations have adopted Communication and Resolution Programs (CRPs), which combine early disclosure, investigation, and proactive resolution. When an investigation reveals that care was unreasonable, the organization offers an apology and fair compensation. Research suggests that these programs can reduce claims and litigation costs while improving patient satisfaction.

Supporting the Disclosure Conversation

Effective disclosure requires preparation and support. Clinicians should be trained in disclosure communication skills. Key principles include being honest, expressing empathy, avoiding blame, explaining next steps, and providing ongoing communication. A disclosure coach or patient safety officer can support clinicians through the process.

Documentation Considerations

Documentation of disclosure should include a factual account of the conversation, who was present, what information was shared, and the patient's or family's response. Documentation should be objective and factual, avoiding speculation about cause. Quality professionals should ensure that disclosure policies are clear and that staff are trained in proper documentation practices.