When should written notification be provided?

The Oregon Patient Safety Commission (OPSC) strongly believes that all patients have a right to know about adverse events that affect their lives. When physicians and healthcare organizations are faced with an adverse event, OPSC recommends that disclosure be made first in the form of oral conversation, followed by written notification. Any disclosure should align with your healthcare organization’s disclosure policy.  

A physician or healthcare organization can provide written notification about an adverse event to the patient or, if the patient is incapable of receiving the information, to the patient’s next of kin (e.g., spouse, family member, or patient representative). Written notification can clarify a patient’s understanding of an event in a way that may be difficult to achieve through oral notification alone. Written notification can also ensure that information not known or addressed in oral conversations is clearly and accurately conveyed to the patient and family.

OPSC recommends that healthcare organizations disclose serious adverse event information as soon as possible after the event occurs. Organizations participating in Oregon’s Patient Safety Reporting Program (PSRP) are required to provide written notification following a serious adverse event (ORS 442.837(4). OPSC recommends that organizations strongly consider the disclosure of non-serious adverse events.

What information should be included in a written notification?

The content of a written notification letter can and should vary depending on the circumstances of the adverse event, the nature of the oral disclosure conversation(s), and the level of involvement that the patient and family have in the aftermath of an event. A written notification, as well as oral disclosure, should include three primary components: show empathy, state the facts, and commit to resolve.

Healthcare organizations should consider clarifying in a written notification that the letter is provided as a follow-up to a previous oral disclosure conversation. Organizations should also consider clarifying the nature of the event for which a letter is being provided.

The Oregon Patient Safety Commission has conversation guidance organizations can use for both the initial oral disclosure conversation and follow-up conversations. The guidance is based on research from leaders in the healthcare communication and resolution field. Every conversation is unique, and you should adjust your approach in consultation with your liability insurer.

How can OPSC support oral disclosure and written notification?

In Oregon, healthcare organizations can use the Early Discussion and Resolution (EDR) process for oral disclosure conversations. EDR establishes confidentiality protections for these important conversations to encourage participants to talk candidly about the harm that occurred and seek reconciliation outside of the legal system. Learn more about EDR

Any disclosure should align with your healthcare organization’s disclosure policy. If the information used for EDR meets your organization’s disclosure policy requirements, it could also be used to satisfy written notification requirements for Patient Safety Reporting Program participants (ORS 442.837(4)).