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[Music] this video is the fourth in a series developed by Alberta health services to support frontline staff in early disclosure conversations the Alberta Health Services disclosure of harm procedure requires that if there has been any harm there is any potential for future harm or if there will be any change in care or monitoring because of something that has happened in our delivery of care we must have a conversation with our patients we call this conversation disclosure in this video you will see an early disclosure conversation where we will not know whether the care we provided contributed to the patient outcome until we have investigated further we do know the patient has had an unfortunate outcome and deserves a discussion the focus in this type of conversation is to empathize with the patient and family it is important that we acknowledge and apologize for the situation but that we do not speculate providing an explanation to the patient will require investigation and further conversation because this is a pediatric case it is important to address both the child and the parent in the conversation I would like you to listen for the key elements that should be included in a disclosure conversation an apology and explanation of what has happened and an explanation of next steps and any future implications to the patient hi Alex and Kate you remember me I'm dr. Keith the one who ordered all those tests to figure out why you're feeling so sick Jacinta and I are here to discuss the results hi Kate hi Alex hi so Alex I heard you had some medicine for your pain earlier you raided your penis a read how would you say your pain is now feeling okay how about you Kate have you noticed any difference with Alex since we're last year I know she's feeling better but she still looks so pale I'm still concerned something just isn't right I know when that's why you brought her back to see us again thanks for doing that you absolutely did the right thing thanks for saying that well the ultrasound results are back and it looks like Alex has appendicitis it appears as or appendix is perforated do you know much about appendicitis no not really well Alex the appendix is the size of your baby finger it's inside your tummy and you can be normal and healthy without your appendix but sometimes your appendix can get sick and we call that appendicitis overtime it can break open and we call that a perforated appendix this is what's happened to you I just can't believe we were here yesterday and they sent her home so sick the doctor didn't even do any tests and now we're back today and you're telling me it's appendicitis and her appendix has burst I'm really sorry you must feel frustrating to find out that your daughter has perforated appendix and to wonder if this diagnosis could have been made sooner can you tell me about your visit yesterday yeah I brought I brought Alex in to have her assess the doctor checked her he really made me feel like it was nothing more serious than the stomach flu certainly didn't mention appendicitis he did say that if she got worse that I should bring her back and this morning there was just no question that we had to come back are you telling me it's been appendicitis all along I know that you're really concerned when you're here yesterday appendicitis is a process that can evolve over time occasionally it's difficult to make the diagnosis early especially in children I know you had a rough night Alex got sicker through the evening and you brought her back for her to see us here today it's not uncommon for there to be a perforation with appendicitis and most children still recover quite well from that we take all visits to the emergency department seriously especially when patients return with worsening symptoms like Alex in situations like this we often review the case to see if there's opportunities for us to have made the diagnosis earlier I think we should do that with Alex's case I definitely think this case needs to be looked at would you like us to share those results with you I would like to know what you find but right now I'm just really concerned about Alex what do we do now well we're going to focus on making you comfortable now Alex it's important to know that you can't have anything to eat or drink and we're going to give you some special medicines through the IV tube called antibiotics and you're going to meet another doctor a surgeon and he's going to talk to you about the best way to treat you usually appendicitis is treated with surgery but sometimes we give the antibiotics some time to work first the surgeon will talk to you about the best path going forward do you have any questions or concerns right now I can't think of any right now but I'm sure when my husband gets here and we have a chance to meet with the surgeon well we'll have some questions Alex sweetie do you have any questions Alex I'm really sorry you've been feeling so sick the past few days while we try to figure out what's causing it the good news is we figured it out now and we can focus on making you feel better if there's any questions or concerns please tell just sentence you can come find me right away Alex will be starting new antibiotics medication in a few minutes and you shouldn't feel anything at all Thanks it is important that all disclosure conversations are documented in the patient's medical record by the person who leads the discussion in the Alberta Health Services disclosure of harm procedure there are 12 key elements that should be documented we hope this video helps you to feel more comfortable in having early disclosure conversations with your patients there will be times patients suffer harm and we don't yet understand whether care provided contributed to the unfortunate outcome we may not have even been directly involved in earlier aspects of the patient's care it is important we start the disclosure process early we can acknowledge and apologize on behalf of our health care team without speculating recognizing that further conversations will be necessary you can get more information and support by accessing Alberta Health Services disclosure resources [Music] you