Reviewed and revised 21 December 2015
- Open Disclosure is the process of communicating with a patient and/or their support person(s) about a patient-related incident or harm caused during the process of healthcare
- Open disclosure after adverse health care events is a national standard, has been implemented in state health policy documents, and is included in the Medical Board of Australia’s code of conduct for doctors
Actively and openly managing such incidents, including through the exchange of timely and appropriate information, is important for:
- The recovery process of patients and next-of-kin
- clinicians to manage their involvement in, and recovery from, adverse events
- Health service organizations to learn from errors
Practicing open disclosure can assist health service organizations develop a reporting culture as it supports clinicians managing unintended patient harm.
Effective and timely communication, transparency and establishing a rapport with the patient and/or family along with an apology when incidents occur might mitigate potential legal action.
APPROACH TO OPEN DISCLOSURE
- Meet the family in an appropriate setting with appropriate support people present
- Acknowledge the incident and its impact
- Explain the known clinical facts
- Apologize for what has occurred
- Reassure and agree on a plan for ongoing care
- Take responsibility and provide reassurance
- Investigate the incident to learn what has happened
- Feedback to patient and staff
- Document by incident reporting tool and in the patient’s medical record
BARRIERS TO IMPLEMENTATION OF OPEN DISCLOSURE
- appropriate timing and place, especially if ongoing clinical responsibilities
- perceptions of legal risk
- lack of education and training
- reluctance to admit error
- uncertainty concerning what and how much to disclose
- variations in state and territory “apology laws”
References and links
- Finlay AJ, Stewart CL, Parker M. Open disclosure: ethical, professional and legal obligations, and the way forward for regulation. The Medical journal of Australia. 198(8):445-8. 2013. [pubmed]
- Koh TH, Alcock G. Open disclosure: appropriate timing is crucial. International journal for quality in health care : journal of the International Society for Quality in Health Care / ISQua. 19(5):326. 2007. [pubmed]
- Lamb R. Open disclosure: the only approach to medical error. Quality & safety in health care. 13(1):3-5. 2004. [pubmed]
- McLennan SR, Truog RD. Apology laws and open disclosure. The Medical journal of Australia. 198(8):411-2. 2013. [pubmed]
- Parker M. A fair dinkum duty of open disclosure following medical error. Journal of law and medicine. 20(1):35-43. 2012. [pubmed]
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.