Manage Risks and Support Patients With Disclosure Best Practices

Even in the best clinical environments, adverse events can happen—from diagnostic errors to unforeseen complications. When they do, how you respond matters. Following best practices for disclosure helps preserve patient trust, while also reinforcing your commitment to transparency, empathy, and high-quality care.

Why Disclosure Is Essential

If an error or unforeseen complication results in patient harm, a medical malpractice claim is a possibility and disclosure may not prevent a claim. Nevertheless, disclosure helps your organization:

• Establish and maintain trust. By being honest about what has occurred, providers develop patient relationships built on a foundation of trust, whereas failing to disclose adverse events or mistakes could erode any trust that already exists.
• Stay compliant. Providers may be required to report adverse events to comply with regulations and to uphold accepted ethical standards.

The Connection Between Disclosure and Informed Consent 

Not all adverse events are the result of errors or oversights. In some cases, certain complications are a known risk of a treatment or procedure. The patient needs to be aware of this ahead of time. Without an understanding of the risks, informed consent is not possible. Furthermore, if a complication occurs and the patient was unaware of the risk of that complication, the patient may be more inclined to blame the provider.

For example, consider a patient who experiences a colon perforation while undergoing a colonoscopy. If the patient was educated about this risk during the informed consent process, they may be more likely to accept it was a possible outcome. However, if the patient was not provided with the appropriate information, or did not understand that this was a risk, they may assume that the provider made an error. 

What Do You Need to Disclose?

Providers should work with their risk management team to prepare for disclosure of events surrounding a serious outcome, which may include misdiagnoses and near misses. An error, such as a wrong limb amputation requires disclosure, as do missed abnormal findings on a mammogram that are found months later on a re-read.

Disclosures should be factual. Providers must honestly state what happened, while avoiding assumptions or speculations.

It is appropriate to disclose responsibility when a mistake is clear – for example, if a surgeon amputated the wrong limb. However, it’s also important to avoid blaming other providers, for example, by saying that a nurse forgot to document something and is therefore at fault. 

Disclosure should also include what will happen next so the patient fully understands what to expect. If appropriate, you can offer additional office visits, diagnostic tests, additional procedures, or referral to another practitioner. Tell the patient what you will do, and don’t make promises you can’t keep. 

When Should Disclosure Occur?

Disclosure should occur as soon as possible after an unanticipated event. Do not make disclosures to a patient until they are medically stable. Do not disclose information to a patient who is confused, sedated, or just coming out of anesthesia.

In some situations, it may make sense to disclose an adverse event to the patient’s family before you can disclose it to the patient. Follow your healthcare organization’s policies, rules from your accrediting bodies, and applicable state, federal, and local laws and regulations when making this decision. 

Prompt disclosure may mean you do not know all the facts yet, and this is fine. Disclose the facts you know and state that you will provide more information as soon as it is available. Do not speculate. 

Who Should Make the Disclosure?

The practitioner involved in the event should disclose the information to the patient or family members whenever it is feasible. However, the practitioner needs to stay composed. If the practitioner is distraught, fearful, or reluctant to engage in the disclosure process, do not force it. Instead, someone else should handle the disclosure, such as a practice manager, hospital risk manager, or other healthcare professional. 

A risk manager, chaplain, registered nurse, or social worker may also be present, as appropriate under the circumstances. However, it’s important to limit the number of participants to avoid overwhelming patients or their families. 

Notify the organization’s legal team and risk manager and involve them in the disclosure process. Contact your malpractice insurance carrier. If the patient or family shows up with an attorney, it’s best to defer disclosure until you can arrange appropriate legal representation. 

The Elements of Effective Disclosure

Disclosure is often difficult for practitioners. Preparation is key. Plan what you will say and review the facts to identify what you can disclose and what you still need to investigate. This will help you avoid saying something that you may come to regret or that turns out to be untrue. It is also important to find a quiet space to have the discussion.

Effective disclosure includes the following elements:

• Clear communication. Explain the facts in simple plain language.
• Factualness. State what happened, avoiding speculation. Avoid words such as error, mistake, fault, and negligence. 
• Humanness. Although it’s important to stick to the facts, you also need to acknowledge the patient’s emotions. Be prepared for anger and avoid becoming defensive.
• Empathy. Express empathy with patients or their families and sympathy for their pain and suffering. It’s appropriate to express regret and acknowledge the patient’s suffering. 

If the situation feels unsafe, end the conversation and exit the room.

Documenting Disclosure

You should thoroughly document the disclosure. Include who was present for the conversation, any questions the patient or family asked, and how you responded.

Do NOT: 

• Amend the medical record following an adverse event.
• Include self-serving explanations, opinions, assumptions, or perceptions.
• Provide information unrelated to the care of the patient. 
• Discuss fault, negligence, or financial settlements.

Helping Practitioners Engage in Effective Disclosure

Organizations should develop policies and procedures to guide the disclosure process. Make sure practitioners know what they need to do and what they should avoid doing. A training program can also help providers with disclosure best practices. Providers who are insured with Coverys can reach out to risk management for guidance. 

This article is based, in part, on “Informed Consent & Disclosure,” a presentation by Christen Marx, RN, BSN, MEd, CPHRM, LNC.