Recommendations for open disclosure

Ensure that there is a suitable place to talk with the patient and/or his/her family members without interruptions.

With the available information well organized, arrange for a senior medical practitioner (it is not always a good idea that the health professional involved in the 2 incident informs the patient), together with another health professional known to the patient (or his/her family) to provide honest information to the patient, and show empathy with their suffering, including making an apology. If various patients are involved, the information should be provided privately to each one. In some cases, the health professional involved, if willing and capable of doing so, may participate in this meeting to inform the patient (though never on their own).

Consider setting up an information team depending on the characteristics and magnitude of the adverse event.

Ensure that the communication does not intimidate the patient. The amount of information given the frequency and the number of professionals who inform should be carefully controlled.

Place importance on supplying information fast, even though it may initially be incomplete, making patients aware of this limitation.

Assess whether there are intrinsic patient related factors (personality, emotional situation, etc.) that weigh against informing the patient directly. This will occur in isolated cases. Assess what the patient(s) and family members know and what they want to know.

Decide, by consensus between a team of professionals, what information is to be given, in what order, and how to apologise with empathy. Confine the discussion strictly to facts and objective data.

Do not make judgements about causality or responsibility, confining the conversation to what is known about the incident and objective clinical data. Avoid speculation. Do not use jargon or words that the patient does not understand. As a rule, avoid terms that could be confusing or have legal implications that go beyond the goal of providing honest information to the patient. In relation to this, it is not recommended to use terms such as error or mistake; rather explain that the outcome has been unexpected. The way this process is carried out should reflect the fact that most adverse events have systemic causes, which are not directly attributable to a specific health professional.

Strive to reduce uncertainty without entering detailed analysis. Pay attention to nonverbal communication, ensuring that the patient and family members feel that the concern and respect shown by the health professional are genuine. Health professionals should talk to each other about the adverse event before informing the patient to reduce the emotional stress and create a climate of trust among healthcare team members.

Meet any special needs of the patient in terms of communication, considering their age, family situation, and language in which they are most comfortable, among other factors.

Record the meeting for informing the patient and/or family members if they give their consent. In such cases, a copy must be made available to the patient on request.

Check whether the patient will or would like to be accompanied by a family member, in the case of patients under 18 years of age.

Request written consent from the patient to share information with specialists in other centres or health services, as appropriate. In such cases, do not supply the name of the patient or other personal details, sharing only the minimum necessary information with third parties.

Have and make available information a legal advice about when and how to proceed with an asset of financial compensation.

Inform the patient and/or family not only about the incident but also about the steps being taken to determine what happened and how to prevent similar events in the future.

Make sure that the patient and/or family members understand the information given and that they do not have any outstanding queries.

Keep a line of communication open between the patient and the contact health professional. Update the information regarding the incident as more details become available.

Make a note in the patient’s medical record specifying the information given to the patient/family with details of their questions and level of understanding of the information.

Plan follow-up to support the patient through the course of their illness and with paperwork, in such cases.

When needed, offer to the patient the option of changing his/her healthcare team.

Other resources – Open Disclosure:

Open Disclosure Handbook: Clinical Excellence Commission. Open disclosure Handbook. Sidney: Clinical Excellence Commission; 2014.
Canadian Guidelines: Disclosure Working Group. Canadian disclosure guidelines: being open and honest with patients and families. Edmonton, AB: Canadian Patient Safety Institute; 2011.
Australian Open Disclosure Framework Australian Commission on Safety and Quality in Health Care. Australian Open Disclosure Framework. Sidney: ACSQHC; 2013.