disclosure of unanticipated outcome

Introduction

Also see medical error.

Procedure

Veterans Administration recommendations:

• Write out a script of what you are going to say beforehand. If the meeting is in person, do NOT have the script in sight.
• Give a clear recitation of the facts. Include time(s) of findings & actions taken.
• Do NOT admit guilt, negligence or wrongdoing.
• If asked 'Did you (or someone) make a mistake?' or 'Is the VA negligent or liable?', say 'I wish I could answer that question, but we don't know yet. Until we can get the answers to your question(s), I can refer you to someone who can help you.' Refer them to a benefits counselor of Regional Counsel (Patient advocate'). Do NOT say 'I have been instructed not to give that information.' Do NOT say 'Our facility will be doing a peer review to determine that' (results of a peer review can not be disclosed).
• The designated health care practitioner gives the patient the facts of what happened. Regional Counsel (for a tort claim) or VBA (1151 claim) determines whether there is liability.
• If the adverse event was something that was discussed in an informed consent discussion, that should be mentioned in an off-handed manner, i.e. 'this was discussed as a possible complication of the procedure'
• There are some situations where giving a heartfelt apology is appropriate, WITHOUT admitting fault. Focus on the patient's injury, i.e. 'All of us are very sorry that (the patient's name) suffured ... These things can happen even when everything is done correctly. At this point in time, we have not confirmed what happened. When we find out, we will let you know.
• Offer support, including corrective surgery, further diagnostic testing & psychologic counseling/support. Listen to the patient's or family's concerns. Provide expressions of concern. Err on the side of taking more time.
• Have a member from Quality Assurance present to answer questions & act as a witness.
• Document information* in a progress note & have the witness cosign.

* Documentation should include:

• time, date & place of discussion
• names & relationships of those present
• a statement that there was a discussion of the unanticipated outcome & exactly what was said; use script (see #1 above) to enter verbatim information
• a statement that as further information becomes available, this information will be shared with the patient, of if the patient consents, with the family
• an offer to be of assistance & the response to it; assistance could include, but is not limited to, follow-up testing, corrective procedures, or psychological support
• any questions asked by the patient or family & the answers given
• if a decision is made to withold some or all information, documentation should be made in a separate report of contact and given to the Regional Counsel, (i.e. deceased patient's HIV status, drug & alcohol treatment, sickle cell anemia status ...)
• any follow-up discussion should be document & should include information consistent with the above

More general terms

• disclosure

Additional terms

• discussing poor prognosis
• medical malpractice, litigation