Ascension Health’s Demonstration Of Full Disclosure Protocol For Unexpected Events During Labor And Delivery Shows Promise

Abstract

Communicating openly and honestly with patients and families about unexpected medical events-a policy known as full disclosureimproves outcomes for patients and providers. Although many certification and licensing organizations have declared full disclosure to be imperative, the adoption of and adherence to a full disclosure protocol is not common practice in most clinical settings. We conducted a case study of Ascension Health's implementation of a full disclosure protocol at five labor and delivery demonstration sites. Twenty-seven months after implementation, the rate of full disclosure had increased by 221 percent. Practitioners saw insurers' acceptance of the full disclosure protocol, consistent and ongoing leadership by local practitioners and hospitals, the establishment of a well-trained local investigation and disclosure team, and disclosure training for practitioners as key catalysts for change. Lessons learned from this multisite initiative can inform liability insurers and guide providers who are committed to ensuring that full disclosure becomes the only response to unexpected medical events.

Strengthening open disclosure after incidents in maternity care: a realist synthesis of international research evidence

“…Ten papers documented three significant research programmes: evaluations of outcomes of national improvement in Australia [ 6 , 48 , 83 ]; process and outcomes evaluation of organisational interventions to improve OD across five pilot US hospitals [ 78 , 79 ]; and documentation of design and development of a perinatal mortality review in England [ 58 , 59 , 70 , 71 , 73 ]. Across all papers, there was limited primary research investigating families’ experiences of OD and what families consider necessary for OD in maternity services (except for Iedema [ 54 ], Quinn [ 81 ], and Stanford and Bogod [ 65 ]).…”

“…Third, a series of studies and reports ( n = 8) documented the effects of multi-faceted interventions to strengthen OD practices organised across a sector, service, or hospital [ 6 , 48 , 54 , 75 – 78 , 81 ]. These interventions were often described as including the development and dissemination of faculty-tailored protocols and guidance, formation of clinical governance revisions, and introduction of general and more specialist HCP training, as well as wider awareness-raising across staff teams.…”

The opioid‐impaired provider: A call for national guidance to maximize rehabilitation while protecting patient safety

“…Notably, Ascension Health successfully increased its employee endorsement of a new full disclosure policy from 10% to 77% over a 27‐month period. A 221% increase in the rate of disclosures ensued across all of its 70 hospitals and hundreds of outpatient facilities 33 . Ascension Health achieved this level of transformative improvement by establishing clear policy and an associated protocol containing highly scripted language (see Table 2).…”

The Definition and Scope of Diagnostic Error in the US and How Diagnostic Error is Enabled

“…This occurs even though full disclosure is an ethical necessity. Clinicians have limited guidance on how to disclose information about diagnostic errors effectively (15)(16)(17). It is not uncommon for physicians who do not order the correct laboratory tests, or take an inappropriate diagnostic or therapeutic action based on the test result, to pass the blame to others, especially those in the clinical laboratory who are not present during the physician-patient encounter and cannot provide the correct information to the patient.…”