Frequently asked questions
What is open disclosure?
Open disclosure is the ďopen discussion of an incident that results in harm (or might result in future harm) to a patient while receiving health careĒ.
What are the key principles of open disclosure?
- Expression of regret
- Disclosure of a clinical incident to a patient
- Staff support and training
- Incompetent adults and minors support
- Patient support
- Clinical governance
What clinical incidents require the open disclosure process to be initiated?
As a matter of policy, patients must be informed of the probable or definite occurrence of a clinical incident that has resulted in, or is expected to result in, harm to the patient, including the following:
- A defined Sentinel Event that is reportable to the Director, Patient Safety Directorate (refer to CIMS Policy (PDF 1.76MB) for WA Health).†
- A clinical incident that has or is expected to have a significant clinical effect on the patient and that is perceptible to either the patient or the health care team.†
- A clinical incident that necessitates a change in the patientís care.
- A clinical incident with a known risk of serious future health consequences, even if the likelihood of that risk is extremely small.†
- A clinical incident that requires hospital / health service staff to provide treatment or undertake a procedure without the patientís consent.†
How long after a clinical incident should open disclosure occur?
The initial disclosure to the patient should occur as soon as possible, ideally within 24 hours of the clinical incident occurring.† The length of time to conduct the open disclosure process will depend on a number of factors, including:
- The clinical condition, emotional and psychological state of the patient.
- The availability of reliable clinical information.
- The availability of key staff and of the patientís relatives / carers.
- Patient preference and privacy.
What is the open disclosure process?
Following detection of a clinical incident the following measures should be implemented by the hospital / health service:
- Report the clinical incident to a relevant authority, in accordance with Department of Health policy.
- Notify the patient of the clinical incident and the facts that are known up to that point in time.
- Undertake an investigation of the clinical incident.
- Provide feedback to the patient.
- Develop an agreed plan for the ongoing care of the patient.
Who should undertake the open disclosure of a clinical incident to the patient?
When a clinical incident occurs and requires disclosure, members of the treating team should determine who is the most appropriate person to speak to the patient.† The person undertaking the open disclosure process should be:
- ideally known to the patient (however it may not always be practical for a health care practitioner, who is involved in a clinical incident, to lead the open disclosure process)
- familiar with the facts of the clinical incident and the care of the patient
- familiar with the WA Open Disclosure Policy and have received appropriate training in the open disclosure process
- able to communicate effectively
- empathetic and able to offer reassurance and support to the patient
- willing to maintain a medium to long-term relationship with the patient, as required.
Ideally, the responsible consultant / non salaried medical practitioner as the most senior member of the team will undertake the open disclosure process.† However, each hospital / health service may delegate this responsibility to an appropriate hospital / health service manager or another member of the treating team.
Check with the local Safety and Quality team in your hospital / health service about the process for undertaking the open disclosure following a clinical incident.
Can I talk with the patientís family about the clinical incident?
Discussing the clinical incident with a patientís nominated relatives / carers / support person etc can only take place with the consent of the patient.
Can I apologise to a patient following a clinical incident?
A patient should receive an expression of regret for any harm that they have suffered as a result of a clinical incident.† An apology or expression of regret must not include any admission of liability or fault.
What can I tell the patient about the investigation into the clinical incident?
If a hospital elects to undertake an investigation of a clinical incident using State qualified privilege, then no information pertaining to the investigation should be released to the patient until legal advice has been obtained.