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What’s New in the
Patient Safety World
May 2025
AAP on Error
Disclosure in Pediatrics
The American Academy of Pediatrics just updated its policy on disclosure of adverse events (AE’s) and medical errors to children and their families (Sigman 2025). The policy emphasizes the importance of a culture of openness and honesty and that reporting adverse events and errors is critical for learning.
The policy distinguishes between “reporting”, which is exchange of information among clinicians and regulators (internally and externally), and “disclosure”, which relates to children and their families. It notes that adolescents often want to be included in such discussions, and also notes there are circumstances where some information regarding adolescents may need to be confidential.
The policy contains an appendix with a nice toolkit consisting of resources for best practices in disclosure.
It also has a section reminding us that it is important to also consider the needs of clinicians involved in adverse events and errors.
It makes the following recommendations for pediatric health care clinicians, practices, and institutions:
1. Develop and implement policies and procedures for identifying and disclosing AE’s to patients and families in an honest and empathetic manner as part of a nonpunitive safety culture.
2. Develop policies and procedures and provide resources to support clinicians and other staff involved in AE’s.
3. Encourage a culture of safety, just culture, and reporting by all staff as well as by patients and families.
4. Identify populations and situations with higher risk for AE’s, such as patients with chronic illnesses and those from historically marginalized or minoritized communities, and partner with families and care teams to help prevent them.
It also has recommendations for medical educators, researchers, and pediatric advocates.
Disclosure and apology are now considered an important part
of the culture of patient safety. We have been strong advocates of disclosure
since the early 1990’s (see our July
24, 2007 Patient Safety Tip of the Week “Serious Incident Response Checklist” for a description a checklist we developed
in the early 1990’s for ensuring that the patient and family are properly
informed about serious incidents).
Some of our prior columns on Disclosure & Apology:
July 24, 2007 “Serious Incident Response Checklist”
June 16, 2009 “Disclosing Errors That Affect Multiple
Patients”
June 22, 2010 “Disclosure and Apology: How to Do It”
September 2010 “Followup to Our Disclosure and Apology Tip of the Week”
November 2010 “IHI: Respectful Management of Serious Clinical Adverse Events”
April 2012 “Error Disclosure by Surgeons”
June 2012 “Oregon Adverse Event Disclosure Guide”
December 17, 2013 “The Second Victim”
July 14, 2015 “NPSF’s RCA2 Guidelines”
June 2016 “Disclosure
and Apology: The CANDOR Toolkit”
August 9, 2016 “More on the Second Victim”
January 3, 2017 “What’s
Happening to “I’m Sorry”?”
October 2017 “More
Support for Disclosure and Apology”
April 2018 “More
Support for Communication and Resolution Programs”
August 13, 2019 “Betsy Lehman Center Report on Medical Error”
September 2019 “Leapfrog’s Never Events Policy”
March 9, 2021 “Update: Disclosure and Apology: How to Do It”
November 2021 “When a Radiologist Recognizes He Committed an Error”
May 31, 2022 “NHS Serious Incident Response Framework”
July 11, 2023 “Error Disclosure in the Real World”
Other very valuable resources on disclosure and apology:
- IHI’s “Respectful Management of Serious Clinical Adverse Events” (Conway 2010)
- The Canadian Disclosure Guidelines (Canadian Patient Safety Institute 2008)
- The Harvard Disclosure Guidelines (Massachusetts Coalition for the Prevention of Medical Errors 2006)
- The ACPE Toolkit (American College of Physician Executives)
- Oregon Patient Safety Commission Oregon Adverse Event Disclosure Guide.
References:
Sigman L, Turbow R, Neuspiel D, Kim JM, Committee on Medical Liability and Risk Management, Council on Quality Improvement and Patient Safety. Disclosure of Adverse Events in Pediatrics: Policy Statement. Pediatrics 2025; e2025070880
American Academy of Pediatrics (AAP). Implementation Tools & Resources. Disclosure of Adverse Events in Pediatrics Policy Statement. 2025
https://downloads.aap.org/DOPCSP/DisclosureofAdverseEventsToolkitAppendix.pdf
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