I still clearly recall an incident that
occurred when I was working in the Emergency Department. It was a busy shift
and all the doctors and nurses were flat out. I had been looking after a
four-year-old child who had come in following a minor head injury.
examined the child and she was being kept under observation. While this was
happening, I moved on to see an 80-year-old lady who had presented with
shortness of breath. I took a history and conducted an examination and then
went to order tests.
One of those tests was a chest x-ray. In my haste,
I did not realise that I had left my computer screen open on the page of the
paediatric patient I was looking after. This meant I inadvertently ordered a
chest x-ray for the child rather than the elderly woman.
I did not
realise this at the time and shortly afterwards the hospital x-ray department
staff came to pick up the paediatric patient for her x-ray. I was attending to
the other patient and had no idea that this was happening.
previously told her that in the circumstances the child did not need any
imaging, so she questioned why an x-ray was being obtained for her child. When
the radiology staff called me in the ED I realised my mistake and asked them to
bring the child back as the x-ray had been ordered in error.
As you can
imagine, the mother was quite upset and annoyed that her child had almost
received an unnecessary x-ray. I knew it was important that I apologised to the
mother directly and took the time to listen to her as she expressed her
I said that I was sorry for what had happened, that it had
been an error on my part and thanked her for raising it with the radiology
staff. I was very nervous approaching the mother initially – I don’t think
anyone likes admitting they were wrong – but after our chat I could tell she
felt she had been listened to. The mother ended up thanking me for taking the
time to explain what had happened.
Needless to say, I was very careful
not to let a similar thing happen again, but I think it helped that I said
sorry quickly and took the time to explain what had happened.
Open disclosure describes the way doctors communicate with
patients when an adverse event or harm has occurred. The aim of this process is
to provide assistance and support to patients and to ensure healthcare
providers learn from adverse events and make changes.
Depending on the
nature of the adverse event, it is an exchange that can occur over more than
one occasion and should include an apology or expression of regret and a
factual explanation of what happened. Giving the patient a chance to convey
their experience is an important component of the dialogue, as is providing
information about actions taken to prevent it re-occurring.
The key to
open disclosure conversations is to say “I am/we are sorry”, offer an
explanation of how or why the event occurred, acknowledge the patient’s
dissatisfaction with the outcome and, importantly, express concern for the
Apologising or expressing regret should not be an admission of
liability. For guidance, find out if your workplace has an open disclosure
Participating in open disclosure is not only beneficial for the
patient. Clinicians can also be profoundly affected by adverse events and
providing support to staff members involved in an adverse event is an important
aspect of the open disclosure process.
Avant supports open disclosure
that is in accordance with the National Open Disclosure Framework.
members contact us prior to becoming involved in the open disclosure process.
For support and advice, call Avant on 1800 128 268. Avant members
can also access personal support and counselling through our confidential
Member Support Program. Call 1300 360 364.
Read ‘Early, effective communication the key to safer practice’
in the Autumn/Winter issue of Connect.
Refer to Avant’s ‘Open disclosure: when to say sorry’ resource page, which
includes a downloadable fact sheet.
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