Disclosing Unanticipated Outcomes to Patients

Open disclosure of unanticipated outcomes to patients is a key component of patient-centered care and is incresingly mandated by hospital acrreditation requirements and some state laws. Yet, transparent communication with patients about unanticipated outcomes appears to be the exception rather than the rule. We describe why the current approach to disclosure is broken and review a new Safe Practice that the National Quality Forum has adopted to enhance the disclosure of unanticipated outcomes to patients. This Safe Practice emphasizes that disclosure and transparency are core components of organizations' patient safety programs. We describe what events are covered by the Safe Practice and articulate the essential steps in the disclosure process. The Safe Practice encourages organizations to create a disclosure and improvement support system, which includes supplying emotional support for caregivers and administrators following serious unanticipated outcomes, providing health care workers with disclosure education and skill building, establishing a process for ready access to adjust-in-time disclosure coaching, and developing processes for measuring and improving disclosure. We then use the "4A's" frameworks of awareness, accountability, ability, and action to delineate what key players should understand and do to begin closing the disclosure performance gap, and list of practical steps that organizations can take to implement this Safe Practice.