Early Discussion and Resolution
Despite everyone’s best intentions during healthcare, things don’t always go as planned. In cases of serious injury or death, there is a constructive way forward.
Though healthcare organizations and providers put the safety of their patients above all else, serious harm or death sometimes occurs. When it does, the patient, their family member, or their healthcare provider can initiate a voluntary conversation using the Early Discussion and Resolution (EDR) process. EDR conversations are protected under state law, giving participants a chance to talk openly about the event and work toward reconciliation.
Who is EDR for?
When serious harm or death occurs from medical care, the EDR is a process for open conversation between the following individuals and organizations.
Oregonians
or their loved ones who experience patient harm
Healthcare providers
involved in a patient harm event
Healthcare facilities
where a patient harm event occurred
How to Start EDR
A patient, their family member, a healthcare provider, or a facility can start the EDR process by requesting a conversation with those involved.
Frequently Asked Questions
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All information in an EDR Request for Conversation is private and will only be shared with the people named in the request. The Oregon Patient Safety Commission is prevented by law from reporting the details of the request to anyone else (ORS 31.260 to 31.280)
All EDR conversations are also protected (ORS 31.260 to 31.280). All written and oral communication connected with the conversation is confidential, may not be disclosed, and is not admissible as evidence in any subsequent adjudicatory proceeding. However, if a statement is material to the case and contradicts a statement made in a subsequent adjudicatory proceeding, the court may allow it to be admitted.
Note: All expressions of regret and apology are protected under ORS 677.082.
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No. The Oregon Patient Safety Commission will not be a part of the conversation. You may invite other people to join you for consultation and support.
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There are no restrictions on who can attend a conversation. Patients, healthcare providers, and facility representatives can attend and may invite other people. For example:
Patients may invite family members, friends, or others who can provide support.
Facilities may invite providers or others with insight into the event.
Providers may invite a trusted coworker who is able to protect the confidentiality of the discussion.
Any party can invite an interpreter.
The parties may mutually agree to hire a mediator. The cost of the mediator will be shared equally unless another agreement is made.
Any party can invite an attorney or liability insurer.
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The Oregon Patient Safety Commission recommends that the initial conversation takes place as soon as possible and generally within 72 hours of discovery of the adverse healthcare event, even if the investigation is not complete. You may be aware of the event immediately, or you may learn about the event when you receive a Request for Conversation. In some cases, the patient request may come long after the event. Patients may be hesitant to raise their concerns at all, may not be aware of the harm immediately, or may not be aware of EDR. Subsequent conversations can be held once more information is available.
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There are no requirements for what to include in a conversation and every conversation will be different.
A conversation may include:
An acknowledgement of the patient’s experience
Information about what happened, why it happened, and whether it was preventable
The possible impact of the event on the patient’s health, treatment, and follow-up care
How additional information will be shared with the patient in the future
An apology
An offer of financial or non-financial restitution
What is being done to improve care for future patients
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EDR does not change federal reporting requirements to the National Practitioner Data Bank (NPDB). The NPDB Guidebook states that, “To be reported to the NPDB, a medical malpractice payment must be the result of a written complaint or a written claim demanding monetary payment for damages.”
If you have questions about NPDB reporting requirements, consult with your malpractice insurance carrier or your legal counsel. The memo signed by the Secretary of the Department of Health & Human Services on May 22, 2014 offers further clarification.
Mediators
Sometimes the path to a resolution can be challenging. The patient, healthcare provider, or facility may choose to hire a mediator to help facilitate the EDR process. A mediator can help all parties discuss concerns and ensure that individual needs and interests are addressed.
Using a mediator for EDR
It’s optional
Any party can ask to use a mediator
If all parties agree to hire a mediator, the cost should be shared unless a different arrangement is made
Find a mediator
Browse our list of qualified mediators to find the right one for your unique situation. You may also choose someone who is not on our list.
To establish mediator qualifications, OPSC worked with the Oregon Mediation Association, representatives from the Alternative Dispute Resolution section of the Oregon Bar Association, and the Task Force on Resolution of Adverse Healthcare Incidents.
Register as a mediator
Interested mediators, who meet the mediator qualifications, are invited to register to be included on our mediator list. Register now.
Mediator qualifications
Experience: 50 cases or 500 hours of mediation
Education: Any
General Mediator Training: 30 hours of education meeting the standards in OAR 325-035-0035, Appendix A, or equivalent training
Subject-Specific Training: 16 additional hours of professionally accredited specific subject training (which may include, but is not limited to, training related to medicine, healthcare, medical or hospital culture, health care transformation, mental health, grief counseling, psychology, risk management, key substantive, procedural or evidentiary laws relating to personal injury or adverse healthcare incidents, and adverse incident mediation discussion or role-playing)
EDR Orientation: By viewing an EDR orientation webinar
Ethics and Standards of Practice: Adherence to professional standards of mediation practice
Request a qualification waiver: In certain circumstances, we may waive one mediator qualification requirement if we believe someone’s overall qualifications meet the needs and intent of the EDR qualified mediator list. To request a waiver, complete and submit a Mediator Qualification Waiver Request Form.
What we’re learning from EDR:
The substantial effect of medical harm on patients and families can be compounded by the response of healthcare providers and facilities.
The impact of medical harm events on healthcare providers has potentially life—or career—changing consequences.
Infrastructure drives how healthcare providers and facilities respond to medical harm events.
Oregon facilities and providers that are eligible to use EDR:
Healthcare facilities
Hospital
Skilled nursing facility
Ambulatory surgery center
Free-standing birthing center
Dialysis facility
Hospital satellite facility
Healthcare providers
Over 20 different types of providers are eligible for EDR, including physicians, nurses, dentists, and pharmacists.
“Conversations are so important at all stages of care… Patients and families almost universally appreciate honesty and candor in these circumstances”
