Jump to comment:

• Re: Improving the governance of patient safety in emergency care: a systematic review of interventions
  Timothy J Schultz
  Published on: 1 April 2016

• Published on: 1 April 2016

  Re: Improving the governance of patient safety in emergency care: a systematic review of interventions

  • Timothy J Schultz, Research Fellow
  • Other Contributors:
    • Kim Hansen and Carmel Crock

  We welcome this systematic review on interventions to improve the governance of patient safety in emergency care settings. This work highlights the value of information contained in adverse events derived from medical record review and incident reporting systems. The authors identified four qualities shared by effective incident reporting systems: (i) staff education on the importance and learning purpose of reporting,...

  Show More

  We welcome this systematic review on interventions to improve the governance of patient safety in emergency care settings. This work highlights the value of information contained in adverse events derived from medical record review and incident reporting systems. The authors identified four qualities shared by effective incident reporting systems: (i) staff education on the importance and learning purpose of reporting, (ii) multiple and constantly available reporting options, (iii) a short reporting form to minimise burden, and (iv) structural feedback by presenting descriptive statistics, findings of incident root-cause analyses and improvement actions (p. 10, [1]).

  Our experience of implementing an Emergency Medicine-specific incident reporting system for use across Australasian hospitals supports these findings. The Emergency Medicine Events Register has supported site champions at participating hospitals to educate fellow staff about incident reporting and provides an on-line (www.emer.org.au), streamlined data collection form tailored to emergency medicine, and automated feedback including descriptive summaries of incidents [2]. Reporting an incident takes just under 6 minutes. Other measures were taken to support reporting, such as the ability to claim continuing professional development points and statutory protection of the data from discovery (qualified privilege) [2].

  The Emergency Medicine Events Register is a voluntary, anonymous system that is managed by an independent third party (the Australian Patient Safety Foundation). The decision for anonymity and independent management was made to enhance system uptake by doctors. Lack of medical engagement in incident reporting is often ascribed to fear and mistrust of incident reporting systems and their misuse by hospital administrators and regulators [3] and a perception that error is inevitable and should be managed 'in-house' or by self-regulation [4]. Hesselink et al's 2016 review also supported our model, with the proviso that implementation of a non-anonymous peer review process had improved reporting rates in one study [5]. Hesselink et al (2016) concluded that "anonymity of reporting and management of incident reports by an independent third party may not be necessary if an incident reporting and peer review process is perceived to be safe" (p. 10).

  We agree with this proposition but believe that, mostly, doctors' perceptions are that incident reporting is not yet considered safe, and therefore that anonymity is an essential element to an incident reporting system. Anonymity imposes limitations on the type of feedback that can be provided - it may only be generic, such as case studies [6]. However, anonymous systems can support hospital-based incident reporting systems that have a strong focus on accountability (as opposed to system learning) and, in general, poor uptake by doctors [7,8].

  Meaningful engagement of doctors has been identified as one of three keys to unlocking the full potential of incident reporting systems [9]. Ownership of patient safety concerns by specialties, such as Emergency Medicine, is a necessary step to developing sustainable system-wide improvements. Specialty led systems that engage trainees and fellows in data collection and analysis, are integrated with professional organisations and their related activities (such as training and education) and are supported by third party patient safety organisations, can promote national and international patient safety agendas [10].

  However, the barriers to doctors reporting incidents are significant. Emergency medicine-specific barriers to incident reporting include: difficulties in training all staff, the need for one-on-one support for site champions, perceived duplication with hospital-based systems and a view that reporting was only a consultant-level activity [2]. Such barriers inform the continued development of the system. One such recent development in the Emergency Medicine Events Register has been an expansion in scope that now allows for consumer reporting [11].

  References

  1. Hesselink G, Berben S, Beune T, et al. Improving the governance of patient safety in emergency care: a systematic review of interventions. BMJ Open, 2016;6:e009837.

  2. Schultz TJ, Crock C, Hansen K, et al. Piloting an online incident reporting system in Australasian emergency medicine. Emerg Med Australas, 2014;26:461-7.

  3. Waring JJ. Beyond blame: cultural barriers to medical incident reporting. Soc Sci Med, 2005;60:1927-35.

  4. Rosenthal M. How doctors think about medical mishaps. In: Rosenthal M, Mulcahy L, Lloyd-Bostock S, eds. Medical Mishaps. Buckingham: : Open University Press. 1999. 141-53.

  5. Reznek MA, Barton BA. Improved incident reporting following the implementation of a standardized emergency department peer review process. Int J Qual Health Care, 2014;26:278-86.

  6. Deakin A, Schultz TJ, Hansen K, et al. Diagnostic error: Missed fractures in emergency medicine. EMA - Emerg Med Australas, 2015;27:177-8.

  7. Hobgood C, Weiner B, Tamayo-Sarver JH. Medical error identification, disclosure, and reporting: Do emergency medicine provider groups differ? Acad Emerg Med, 2006;13:443-51.

  8. Rowin EJ, Lucier D, Pauker SG, et al. Does error and adverse event reporting by physicians and nurses differ? Jt Comm J Qual Patient Saf, 2008;34:537-45.

  9. Mitchell I, Schuster A, Smith K, et al. Patient safety reporting: a qualitative study of thoughts and perceptions of experts 15 years after 'To Err is Human'. BMJ Qual Saf, 2015, published online first: doi:10.1136/bmjqs-2015-004405

  10. Jones DN, Benveniste KA, Schultz TJ, et al. Establishing national medical imaging incident reporting systems: issues and challenges. J Am Coll Radiol, 2010;7:582-92.

  11. Emergency Medicine Events Register. Consumer Report. 2016.http://www.emer.org.au/consumer-report.html (accessed 23rd March 2016).

  Conflict of Interest:

  None declared

  Show Less

  Conflict of Interest:
  None declared.

  • Back to top