Definition
- Open discussion with a patient and family about an adverse event that caused harm
- Guided by the Australian Open Disclosure Framework (ACSQHC)
- Applies to all adverse events causing harm, including near misses where the patient is aware
- Part of NSQHS Standard 1 and an expectation of the Medical Board code of conduct
Elements
| Element | Content |
|---|---|
| Apology | A sincere expression of regret, including the word sorry |
| Facts | What happened, as known at the time |
| Consequences | Effects on the patient and what care follows |
| Prevention | What is being done to prevent recurrence |
| Follow up | A named contact and further meetings |
- Apology laws in most states protect an expression of regret from being an admission of liability
Process
- Initial disclosure early, within about 24 hours
- Senior clinician leads higher level disclosures
- Lodge an incident report
- Document each discussion
- Support staff involved, who may suffer as second victims
- Lower level disclosure can happen at the bedside with the treating team
- Higher level disclosure follows a planned meeting with senior staff and a support person for the patient
- Avoid speculation and blame
- Offer practical support such as costs of further treatment where appropriate
- Provide a written summary after the meeting
Fellowship Examination
- Disclosure scenarios include wrong site surgery, a retained swab and a missed fracture
- Examiners look for an early apology, facts, a plan and follow up
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.