Unexpected or adverse incidents

This fact sheet provides a guide for health practitioners when responding to an adverse event. 

This could include where unexpected harm has occurred, a patient or their family member has expressed concern or dissatisfaction with your care or something has occurred which you think is outside what you would normally expect in your practice.

Open disclosure is a process whereby patients and those supporting them are informed of adverse events in a timely, sensitive and appropriate manner, and how it may impact the patient’s ongoing condition and care. 
 
Open Disclosure can differ based on the circumstances and that includes hospitals and small practices.  
 
In a hospital setting, open disclosure will usually be guided by hospital protocols and processes, and involve a variety of staff.  However, in a private practice setting, it is often up to the health practitioner involved to work out an appropriate process. 
 
The Australian Commission on Safety & Quality in Health Care (ACSQHC) provides these guidelines and we recommend you refer to them.
 
ACSQHC has also published excellent resources on its website.
 
Adverse events may result from acts of commission or omission and include:  

• Untoward incidents
• Therapeutic misadventures
• Iatrogenic injuries
• Other adverse occurrences directly associated with medical care or services.

The following is a guide to responding to an adverse event:

Ensure that the patient is seen and treated immediately and kept safe from further harm

• Someone needs to take immediate responsibility for the event
• A senior staff member is appropriate.

Talk to the patient and/or family about what happened as early as it is appropriate

• Set aside an appropriate length of time
• Be open and honest and provide a factual account of what happened and what might still be unknown. It takes time and careful analysis to determine all the facts
• Reassure the patient that they are safe
• It is appropriate to express regret and say “sorry” that the harm occurred - A guide to saying sorry or expressing regret
• Ask the patient questions and reassure them that you have heard by responding to their concerns
• Do what you say you are going to do – follow through
• Avoid speculation and undue criticism of yourself – it is always difficult for you to judge objectively your responses to a situation after it happens
• Avoid criticism of other practitioners involved in the patient’s care – this is not an issue for you to determine, and you may not know all the relevant facts. 

Plan ongoing treatment

• Tell the patient that you want to continue caring for them, where appropriate
• Be clear about what they should expect following the adverse event (e.g. longer hospital stay, surgical or medical intervention, temporary or permanent injury)
• Involve other health care professionals, such as mental health professionals, if it is deemed appropriate and necessary    
• Depending on the circumstances, it may be appropriate to offer a second opinion, or transfer to the care of a colleague. 

Documentation

• Make accurate and comprehensive notes in the health records
• Objectively record facts
• Clear and comprehensive – remember that the notes may be scrutinised
• Avoid words that suggest apportionment of blame
• Describe in detail the conversations that you have with the patient and family - A guide to open-disclosure-documentation
• Enquire about and comply with the reporting requirements and actions specific for that hospital
• Look after yourself and seek support or assistance if you are feeling troubled by what occurred.

Here are a few links that may help:
MIGA Doctors' Health
Doctors' Health SA

The Extras

• Provide the patient and family with your direct number, if appropriate
• If you are going to be unavailable let them know that and provide an alternative option
• In some situations it may be appropriate to consider the patient’s out of pocket expenses as a result of the adverse event – you should consult with MIGA claims solicitors before considering this.

Contact MIGA Claims and Legal Services team for medico-legal advice about the incident and to discuss the way forward.