An adverse event is unintended harm to a patient caused by medical management or care, rather than their underlying illness. These events range from mild complications to severe injuries that may require additional treatment or prolonged hospitalization. While all medical care carries inherent risks, many adverse events are preventable, often stemming from system failures or human errors. When an unexpected or harmful outcome occurs, healthcare providers have an ethical obligation to be transparent and honest with the patient about what happened. This disclosure is foundational to maintaining trust and allowing the patient to make informed decisions about continued care.
The Essential Information That Must Be Shared
The initial conversation following an adverse event must focus on relaying factual information in clear, non-technical language. Providers must give a simple, direct description of the event: what happened to the patient. This explanation should detail the sequence of events without speculation or assigning blame, focusing only on verifiable facts available at that moment.
The patient needs to understand the immediate consequences of the event and the steps being taken to mitigate the resulting injury. This includes discussing the known or suspected cause. If the cause is immediately obvious, such as an admitted error, it should be clearly communicated; otherwise, state that a full investigation is required.
Providers must explain how the outcome will affect the patient’s ongoing treatment plan and prognosis. Since disclosure is a process, the healthcare team must commit to providing frequent updates as new information is uncovered. This ensures the patient understands their current status and can participate in decisions about their next steps.
Guidelines for Effective Communication
The manner of disclosure profoundly influences the patient’s reaction and future relationship with the healthcare system. The conversation should occur as soon as possible after the event, once the patient is stabilized and initial facts are gathered. This prevents the patient from feeling that information was withheld.
The discussion must take place in a private, quiet, and comfortable setting, ensuring sufficient time without interruption. The attending physician is typically the best person to lead the conversation, often supported by a risk manager or patient advocate. The tone must be empathetic and compassionate, acknowledging the patient’s distress.
A sincere apology is a required component of open disclosure and serves as a healing mechanism for the patient. Apologizing for the patient’s experience of harm is always appropriate. Many states have “I’m sorry” laws designed to promote this expression of empathy without legal risk, as it is generally not an admission of legal liability.
Immediate Institutional Response and Patient Support
Following disclosure, the institution must implement a structured response that supports the patient and addresses the event’s root causes. The first priority is ensuring continuity of care, often by offering to cover the costs of necessary treatment resulting from the adverse event. This commitment to financial and medical support mitigates the patient’s burden and demonstrates accountability.
The institution must immediately initiate an internal investigation, such as a Root Cause Analysis (RCA), to determine the underlying system failures that contributed to the event. The patient should be informed that this investigation is underway and that its purpose is to learn from the event to prevent future occurrences.
Emotional and psychological support services must also be offered to the patient and their family. Since experiencing an adverse event can cause trauma, institutions should connect patients with resources like counseling or social work services. The institutional response is highly influential in restoring the patient’s trust.
Patient Rights and Next Steps
After an adverse event, the patient retains certain rights and has multiple avenues for action, which the healthcare provider should explain. Understanding these rights empowers the patient to choose the next steps appropriate for their situation.
The patient’s rights and options include:
- Requesting and receiving copies of their complete medical records for documentation or seeking a second opinion.
- Obtaining an independent review of the case from an outside medical specialist.
- Filing a formal complaint or reporting the event to external oversight bodies, such as state licensing boards or The Joint Commission.
- Seeking legal counsel to explore a medical malpractice claim if they believe the injury resulted from negligence.
While open communication may reduce the likelihood of a lawsuit, the patient’s right to pursue legal action remains.