Reports From the Field

Attitudes of Physicians in Training Regarding Reporting of Patient Safety Events

Journal of Clinical Outcomes Management. 2015 November;22(11)

References

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Results

A total of 80 eligible residents and fellows received the survey, and 49 completed it (61% response rate). Almost three-fourths of respondents indicated that they knew whose responsibility it is to report safety events. Over half indicated that they forget to make a report when the ward is busy. Over two-thirds indicated that they felt it was useful to discuss safety events. We anticipated that trainees would have concerns about disciplinary action and blame. We found that 28.5% worried about disciplinary action, but 40.8% did not. Asked whether they agree or disagree with the statement “Junior staff are often unfairly blamed for adverse incidents,” over half neither agreed nor disagreed; almost one-third disagreed, and only 16.3% agreed. Complete data on the responses are shown in Table 1 .

When asked to outline reasons for not reporting incidents, participating residents and fellows identified the complexity of reporting system, lack of feedback, lack of updates about new system changes resulting from safety event reporting,

reporting not a priority in clinical workflow, and fear of losing anonymity if safety event investigated as the most common reasons ( Table 2 ).

Discussion

This pilot study demonstrated that resident and fellow physicians in the department of internal medicine at our institution understand the necessity of reporting and that it is their responsibility; however, it is not a priority during the busy clinical workflow on the wards. Other investigators have observed similar attitudes/behaviors among physicians across teaching hospitals in the United States [10,12]. In a study by Boike et al [15], despite positive attitudes among internal medicine residents regarding reporting, increased reporting could not be sustained after the initial increase.

Our finding that 71.4% felt it was useful to discuss safety events is similar to Kaldjian et al’s [16] finding that 70% of generalist physicians in teaching hospitals believed that discussing mistakes strengthens professional relationships. The physicians in that study indicated that they usually discuss their errors with colleagues.

Prior to the development of the inpatient safety committee, the institution had a basic resource in place for reporting events, but there were minimal contributions from resident and fellow physicians. It is likely that the higher rates of reporting by nursing, laboratory, and pharmacy services (data not presented) that were seen are due to a required reporting protocol that is part of the workflow.

Since the inception of the inpatient safety committee, we have started several projects to build upon the foundation of positive resident and fellow physician attitudes. Based on the input of resident and fellow physicians, who are the front-line agents of process improvement, the existing patient safety reporting method was revised and reorganized. Previously, an online standardized patient safety event form was accessible after several click throughs on the institution’s homepage. This form was confusing and laborious to complete by residents and fellows, who were already operating on thin margins of spare time. The online reporting form was moved to the homepage for easy access and a free text option was enabled.

Another barrier to reporting was access to available computers. As such, the committee instituted a phone hotline reporting system. Instead of residents entering events using the Midas information management system, they now are able to call an in-house line and leave an anonymous voicemail to report safety events. Both the online and phone hotline reporting systems are integrated into a central database.