Open Disclosure and Anaesthesia

Open Disclosure has become a prominent theme in the Irish medico-legal world following the high-profile litigation between Vicky Phelan, the Health Service Executive (HSE) and Clinical Pathology Laboratories. This action triggered a national review and subsequent publication of the Scoping Inquiry into the CervicalCheck Screening Programme by Dr Gabriel Scally in 2018 (1). The report detailed the voluntary nature of the Open Disclosure process in the Irish Health Service, and the paucity of training and audit of Open Disclosure practice among clinicians (2). Open Disclosure involves an open discussion with a patient, and/or their relatives about an incident that resulted in harm to that individual while they were receiving healthcare (3). The elements of disclosure include an apology, an explanation of the event and the follow-up measures to prevent recurrence (3). The benefits of the widespread practice of Open Disclosure are threefold; it improves patient safety by allowing investigation and follow-up of adverse events; it increases trust in the patient and clinician relationship; and facilitates appropriate resolution for patients, their support people and staff members following an incident (5). The Civil Liability (Amendment) Act 2017, protects an apology given by a clinician in an Open Disclosure forum from future use in litigation (4), although the mechanism required to avail of this protection are cumbersome, intrusive, overly-legalistic and rarely used in practice. Anaesthesiology is a unique hospital specialty with practitioners often building a rapport with a patient immediately before anaesthesia. The very nature of our interactions with patients can construct barriers to effective and timely disclosure. A recent analysis of knowledge and understanding of Open Disclosure amongst anaesthesiology trainees in Ireland demonstrated poor understanding of both the concept and practice of the process (6). Barriers to disclosing adverse events mirrored international research and included lack of formal training, lack of organisational support and the prevailing institutional attitude. A culture of judgement and blame within the health service was also highlighted as a barrier. This study also uncovered a reticence amongst Non-Consultant Hospital Doctors (NCHD’s) to submit near-miss or adverse events for discussion at morbidity and mortality meetings suggesting a lack of insight and engagement in a culture of patient safety. Worryingly, many respondents highlighted symptoms of second-victim phenomenon following personal experience of a medical error and were unable to access or locate support when needed.