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In December 2012, Beth Israel Deaconess Hospital-Milton (BID-Milton) launched its formalized CARe program. As part of the initial and ongoing implementation process, the hospital deployed CRICO’s Guidelines for Disclosure after an Adverse Event.  This checklist approach has ensured that respondents and participants focus on the key objectives and goals of the program (to see the checklist click here).

Since the CARe program’s inception, the BID-Milton CARe team has participated in several patient/family meetings. Prior to each meeting, members prepare and discuss the event information and findings as well as strategies and logistics ranging from who will greet the patient/family at the hospital entrance, to seating arrangements in an appropriate setting, who will lead the discussion, how it will be presented and how members will re-iterate their apology on behalf of the hospital to the patient/family member.

It would be disingenuous to claim that members of the hospital team have ever been able to predict the exact course of these meetings or the emotional status of the patient/family members. As a result, CARe team members enter these meetings pensively.

Patient/family member’s reactions are variable and depend on the individuals.  We have had meetings where patients/families express everything from appreciation to anger, exhaustion, or resignation, while still others sat quietly and refrained from asking any questions or making comments.

Despite our best efforts to communicate with the patient/family, sometimes the meeting may not provide the answers that will allow the patient and/or family members to achieve resolution, particularly if the findings demonstrate that the event was not preventable and/or the medical standard of care was met.  Nevertheless, regardless of the how the meeting ultimately reaches its conclusion, there has consistently been the opportunity for care providers to communicate directly with the patient/family and express their sincere apologies.

Regardless of the varied discourse and unexpected turns, a common thread identified by the CARe team in all meetings was the sense that communicating and being transparent was the right thing to do for the patient, family member and caregivers. Closure is a journey. Our experience attending and facilitating these meetings has demonstrated to us that they are an important step on that journey.   

Sometimes an apology may be all that can be offered and perhaps more importantly, all that is actually needed.

Alexander J. Campbell MSN, RN, NE. BC, CPHQ, Director of Health Care Quality & Patient Safety, BID-Milton

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