Appendix 5

Disclosure Meeting Protocol

  1. Determine where the meeting will take place:
    • It should be a quiet, private, and comfortable setting.
    • There should be no barrier (table or desk) between the physician and patient.
    • All beepers/pagers/phones should be turned off.
  2. Decide on the agenda in advance.
  3. Communications must be consistent—agree in advance on what is known, on what is not, and on what must await further investigation.
  4. Be prepared to say “I don’t know” if some of the facts are unknown.
  5. The regional patient safety risk manager will coach the physician on disclosure communication (use of empathetic statements, silent listening skills, disclosure, and apology) immediately prior to the disclosure meeting.
  6. The treating physician is usually responsible for the disclosure.
  7. As a general rule, the physician should communicate his or her acceptance of overall responsibility but should not make admissions of personal negligence or fault.
  8. Document the meeting in the patient’s medical record according to standard practice. An example of this documentation is shown in Appendix 1).
  9. Avoid becoming angry, emotional, or defensive.
  10. Stay away from blame and don’t finger point!
  11. Avoid using names; focus on what happened, including system error(s) if present.
  12. Follow these four steps in the disclosure:
    • Tell the patient/family what happened—limit the discussion to known facts; avoid speculation.
    • Assume overall responsibility as the patient’s caregiver—not only for what happened, but also for updating the patient and family, monitoring, and managing complications, etc.
    • Apologize if appropriate—when a personal apology is appropriate, the person responsible for the adverse event should make the apology.
    • Explain what will be done to prevent this from happening again—if the event was preventable, patients want to know that this won’t happen in the future to someone else.
  13. Future consequences of the injury (such as hospitalization, medications, surgery, future medical treatments, or disability) should be disclosed.
  14. Make time for the patient/family to ask questions and express their feelings. Communicate to the patient/family that they are being heard and their concerns taken seriously.
  15. Be prepared to handle questions that might arise regarding compensation. (Is the bill being written-off? Is it being held pending further investigation?)

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