Disclosing Unanticipated Adverse Outcomes
April 24, 2023 | Ambulatory Care Risk Management
Unanticipated adverse outcomes may be the result of medical error or simply the risks inherent in a medical condition and its care. In a 2019 Medscapepoll, approximately one in six physicians reported making a diagnostic error every day (with emergency physicians highest at 26%). (Frellick) Some errors cause increased morbidity risk or are fatal; tens of thousands of patients die each year as a result of medical error (Kohn et al.). Healthcare organizations need basic, general plans for addressing significant adverse events. In addition, a disclosure policy is a potent weapon in the organization's arsenal to manage the aftermath of an error or other unexpected event.
While not every situation can or should be managed through disclosure or full disclosure (MedPro Group), hundreds of hospitals in the United States have implemented risk-management-endorsed mechanisms for communication with patients about adverse events, in response to legislative momentum, tort system concerns, patient safety interests, professional group recommendations, and ethical claims (Brown et al.). Hundreds of organizations have adopted communication and resolution programs (CRPs), including postacute-care organizations and pediatric facilities. See Real-World Examples of Disclosure Policies for examples from actual organizations.
Few would argue against the idea that patients are entitled to information about their medical care regardless of whether a negative outcome was a known complication or unanticipated, nor is there much disagreement that such disclosure should come in the form of a benevolent gesture. But when information is not shared, patients and families may question and regret their decisions to pursue, choose, agree to, or monitor care—a traumatic postevent response that can add to the devastation of loved ones, exacerbating their own sense of failure in the event and the feeling that they need to turn that frustration into action. Without the facts, they may create their own narrative about the adverse event.
"Processes can be better. Yet, continually dwelling on these errors without discussing or contemplating the errors of our own choices is a failure of our profession. Rarely these days are we confronted with the eternal question of medicine: should I have acted differently?"
Source: Prasad, V. When We're All Responsible for a Patient's Death, No One Is. Medpage Today. 2021 Nov 16.