title: What, who, when, where and how to inform patients after an adverse event: a qualitative study.
abstract: OBJECTIVE
  To explore suggestions and recommendations for conducting open disclosure with a patient after an adverse event in a setting without professionals' legal privileges.
  
  
  METHODS
  Qualitative study conducting focus groups/Metaplan. This study was conducted with physicians and nurses from Primary Care and Hospitals working in the public health system in Spain.
  
  
  RESULTS
  Twenty-seven professionals were involved 8-30 years of experience, 15 (56%) medical and 12 (44%) nurses, 13 (48%) worked in hospitals. Consensus was obtained on: how (honesty and open and direct language), where (avoid corridors, with privacy), and when to disclose (with agility but without precipitation, once information is obtained, and after reflecting on the most suitable according to the nature of the AE). There was controversy as to what to say to the patient when the AE had serious consequences and doubts about what type of incidents must be reported; who should be required to disclose (the professional involved in the AE or other professional related to the patient, the role of the staff and the management team); and in which cases an apology can be a problem.
  
  
  CONCLUSIONS
  The severity of the AE determines who should talk with the patient in both hospital and primary care. The most appropriate way to convey an apology to the patient depends of the AE. An early, direct, empathetic and proactive action accompanied by information about compensation for the harm suffered could reduce the litigation intention.
authors.affiliation: Departamento de Salud Alicante-Sant Joan, Alicante, España; Universidad Miguel Hernández, Elche, España. Electronic address: jose.mira@umh.es.
authors.forename: José Joaquín
authors.initials: JJ
authors.lastname: Mira
authors.affiliation: Consorcio Sanitario Integral, L'Hospitalet de Llobregat, Barcelona, España.
authors.forename: Lena
authors.initials: L
authors.lastname: Ferrús
authors.affiliation: OSI Donostialdea, Donostia, España.
authors.forename: Carmen
authors.initials: C
authors.lastname: Silvestre
authors.affiliation: Servicio Madrileño de Salud, Madrid, España.
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Olivera
mesh_terms: D017408:Guidelines as Topic; D006761:Hospitals; D006801:Humans; D019300:Medical Errors; D011320:Primary Health Care; D036301:Qualitative Research; D014342:Truth Disclosure
keywords: Adverse events; Atención Primaria; Eventos adversos; Healthcare providers; Hospital; Patient safety; Primary care; Profesionales de la salud; Seguridad del paciente