Published: 08/2026
Disclosure is a process rather than a discrete event. Disclosing information about adverse events benefits both patient and members of the entire care team. When done artfully, these discussions can rebuild trust and promote an ongoing care relationship. Disclosure is appropriate when an unanticipated outcome and/or reasonably preventable harm occurs. Reasonably preventable harm means a systems failure or individual’s mistake that necessitates additional monitoring or treatment and/or causes temporary or permanent harm or death. It is important to distinguish harm from natural disease progression. After an adverse event, address the patient’s health care needs first. After this, it is important to proceed with the first disclosure discussion as soon as possible.
Why should disclosure be performed? Although initial studies demonstrated that disclosure reduces liability risk, subsequent studies have questioned this. Disclosure evidences a focus on the patient and enables the patient and their family and friends to actively participate in their care. It promotes trust in the involved care team members and the organization. It also promotes care givers’ well-being.
After an adverse event, it is important to plan for the discussion with the patient or their activated healthcare agent (HCA). The attending physician, as leader of the care team, should lead the disclosure. First, it is important to gather as much information about the event as possible. A group huddle may enable the best collective understanding. To ensure that all relevant information is communicated effectively, prepare a written outline of the facts currently known and answers to likely questions, including:
- The impact of the event on the patient’s care and short- and long-term health,
- The planned follow-up care and treatment, and
- Why the event happened.
Also, plan to:
- Consult the risk team or senior leaders as appropriate, including when the attending desires guidance, with concerns for legal risk, and/or when severe harm or death resulted.
- Avoid speculating or criticizing the care provided by other care team members. A thorough review often identifies systems failures as the root causes and finds that individuals made reasonable decisions based on the information available.
- Have an additional health care team member present (e.g., patient’s nurse, charge nurse, patient advocate, leader) to help facilitate the discussion.
- Use language consistent with the patient’s/HCA’s medical literacy and, if necessary, an interpreter.
- Show empathy and compassion.
- Expect intense emotions – these are normal. Try not to become defensive and adhere to the planned discussion elements.
- Employ de-escalation techniques as necessary.
- Pause intentionally to allow for questions and reactions.
- Intermittently verify the patient/HCA’s understanding of the discussion.
- Conclude the discussion by promising transparency and that they will receive follow-up with additional information. Provide a contact for future questions.
After the initial discussion, record the conversation and garner additional resources by filing a safety event. To support care team members, consider engaging the organization’s peer support program.
Example:
In the emergency department, a postpartum patient is diagnosed with a significant pelvic infection. During the exam, the resident removes two retained 4”x4” gauze sponges by folding them into her gloves. The resident informs the patient that she requires admission for intravenous antibiotics and steps out. She calls her attending, who comes to the bedside to prepare to disclose the retained sponges. The record shows that 50 sponges were used and the counts were marked correct.
In the room, the attending shares that resident removed two sponges from the vagina that have been inside since the delivery and likely contributed to the infection. The attending apologizes for the error. The patient’s husband replies by shouting, “Who screwed up?” and threatens to sue. The attending replies, “It was likely a team error. At every delivery, we count the sponges twice. Somehow, the final count was incorrect. Even though the repair was difficult, the sponges should not have been left inside.” In response to the couple’s concern about maintaining her milk supply, the attending assures them that she will have help pumping every three hours until she feels well enough to put her baby to breast. Additionally, the attending promises the patient and her husband that the healthcare team will follow them closely and they will have ample opportunity to ask further questions.
During an office visit two weeks after hospital discharge, the couple thanks the attending for her honesty, noting that she could have kept the sponges a secret. They share that they understand how the count could have been off because of how challenging the repair appeared. They go on to celebrate how well the repair has since healed. The physician-patient relationship appears stronger.
Additional Resources
- Committee on Patient Safety and Quality Improvement. American College of Obstetricians and Gynecologists. Disclosure and discussion of adverse events. Obstet Gynecol. 2016;128:e257-61
- Agency for Healthcare Research and Quality. Communication and optimal resolution (CANDOR). Rockville, MD: 2016 Apr. Content last reviewed August 2022. [cited 2026 Jul 15]. Available from:
https://www.ahrq.gov/patient-safety/settings/hospital/candor/index.html