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Gampetro PJ, Nickum A, Schultz CM. Perceptions of U.S. and U.K. Incident Reporting Systems: A Scoping Review. J Patient Saf 2024; 20:360-369. [PMID: 38682884 DOI: 10.1097/pts.0000000000001231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
OBJECTIVE The aim of the study is to evaluate the extent, range, and nature of the literature that concerns healthcare providers' perceptions following the use of incident reporting systems (IRSs) in the United States (U.S.) and the United Kingdom (U.K.). Literature was compared describing providers' perceptions of reporting patient safety incidents using IRSs from healthcare systems built on public, private, for-profit, or nonprofit insurers in the U.S., with providers' perceptions using an IRS within a universal government supported healthcare system in the U.K. METHODS This scoping review searched literature from 4 electronic databases, producing 4863 articles between January 2010 to March 2023. RESULTS Eleven U.S. and 8 U.K. articles met the inclusion criteria. Providers described system and individual barriers when using IRSs. The U.S. providers described more concerns regarding individual barriers (fear of punitive response or retaliation, feel incapable or shamed, unsure of what constitutes a patient safety incident, and concerned about litigation) than providers in the U.K. Both countries had similar responses regarding system barriers, except for U.K. providers who were more concerned than the U.S. about damage to professional culture. Providers in both countries believed incident reporting was ineffective and time consuming with hospital leaders seldom acknowledging or integrating improvement measures based on reported incidents. CONCLUSIONS Sustainable improvements in patient care must be driven by hospital leadership who create just cultures where reporting of safety concerns is encouraged and respected within nonpunitive milieus.
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Affiliation(s)
- Pamela J Gampetro
- From the University of Illinois Chicago, College of Nursing, Chicago, Illinois
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Strengths and weaknesses of the incident reporting system: An Italian experience. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2023. [DOI: 10.1177/25160435221150568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
One of the cornerstones for enhancing the patient safety culture is the incident reporting system (IRS). It is a process for detecting, reporting, collecting, and summarizing adverse events (AEs) and near-misses in healthcare, and so it represents a vital tool for clinical risk management. We analyzed the 5-year experience of a third-level hospital's IRSs, showing its trends and highlighting its main strengths and weaknesses. Patients’ falls and physical or verbal aggression toward the providers or between patients are the most reported events. Underreporting is the main limitation of the system, especially among nurses. Visible actions, forceful analysis of the reports, operators’ education, no-blame culture promotion, and organizational adjustments may improve operators’ adherence to IRS. Providers do not willingly inform patients’ relatives about fatal incidents. Despite that, the IRS is far from its potential, and the number of data collected has increased.
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Maeda Y, Suzuki Y, Asada Y, Yamamoto S, Shimpo M, Kawahira H. Training residents in medical incident report writing to improve incident investigation quality and efficiency enables accurate fact gathering. APPLIED ERGONOMICS 2022; 102:103770. [PMID: 35427906 DOI: 10.1016/j.apergo.2022.103770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 06/14/2023]
Abstract
We assessed whether training on writing readable and accurate medical incident reports (IRs) improves the quality of fact description. In this training, 124 residents created fictional IRs. We provided tips, including using When, Where, Who, What, Why, How. We compared the fictional IRs with and without tips, and the trainees' and non-trainees' IRs submitted in the first five months after training. Results indicated that the subject words in IRs were more clarified and the readability was improved. The fictional IRs using tips were more accurate, with increased descriptions of the patient's background, reporter's actions, team members' actions and conversations, safety check procedures, result of the error, and post-incident response. The reporter's actions, work procedures, and environment were more clarified in the trainees' IRs than in the non-trainees' IRs. This training may help analysts comprehend the sequence of and underlying factors for reporter's actions based on IRs.
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Affiliation(s)
- Yoshitaka Maeda
- Medical Simulation Centre, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan.
| | - Yoshihiko Suzuki
- Medical Simulation Centre, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan.
| | - Yoshikazu Asada
- Medical Simulation Centre, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan.
| | - Shinichi Yamamoto
- Centre for Graduate Medical Education, Jichi Medical University Hospital, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan.
| | - Masahisa Shimpo
- Centre for Quality Improvement and Patient Safety, Jichi Medical University Hospital, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan.
| | - Hiroshi Kawahira
- Medical Simulation Centre, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan.
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Bertram I, Cantelo J, Hutton W, Kirkham H, Scallan N. Sins of Omission: Are junior doctors failing to report clinical incidents, and if so, how can we better support them to do so? JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2021. [DOI: 10.1177/25160435211044588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives University Hospitals Birmingham's (UHB) Foundation Doctors should log clinical incidents via the Trust's incident reporting system. Anecdotal reports suggest under-reporting is commonplace. It is therefore important to identify the proportion of Foundation Year 1 (FY1s) who witnessed but did not report incidents and identify and weigh perceived barriers to reporting. We can then suggest strategies to address these barriers and repeat our data collection. Methodology We performed an analysis of anonymised data from the Trust's Datix Incident Reporting system alongside an anonymised survey to determine the proportion of FY1s witnessing reportable clinical incidents, and the proportion successfully reporting an incident in the 2017/18 academic year. The survey also gathered data on FY1 perceptions of barriers to reporting. We went on to discuss our results with UHB management and suggested several strategies to improve reporting, prior to repeating data collection for the 2019–20 academic year. Results 36.4% FY1 doctors surveyed in 2017–18 reported witnessing at least one clinical incident that they did not report. 37.0% FY1 doctors surveyed in 2019–20 reported the same. Respondents felt time taken to complete forms and system complexity were the key barriers to reporting. Conclusion Results show that over a third of FY1s at UHB had witnessed but not reported at least one clinical incident each year. The evidence-based strategies suggested to the trust in 2018 and 2020 included FY1 education on incident reporting, early senior clinician involvement in the reporting pathway, and a streamlined reporting system integrated with existing infrastructure. These have not been implemented.
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Verulava T, Jorbenadze R, Ghonghadze A, Dangadze B. Introducing Critical Incident Reporting System as an Indicator of Quality Healthcare in Georgia. Hosp Top 2021; 100:77-84. [PMID: 33999761 DOI: 10.1080/00185868.2021.1926384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Critical incident reporting systems (CIRS) have become the most common patient safety tools in healthcare. The purpose of this study was to present the development of CIRS in Georgia. A quantitative approach using a cross-sectional survey was adopted. Critical incidents were mainly derived from surgical disciplines. The highest number of cases was registered by nurses. The most common critical incidents were due to lack of personal attention. CIRS can be seen as an effective clinical risk management tool that can be used to identify potential sources of critical incidents and help ensure patient safety at a healthcare organization.
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Affiliation(s)
- Tengiz Verulava
- School of Medicine and Healthcare Management, Caucasus University, Tbilisi, Georgia.,Faculty of Social and Political Sciences, Ivane Javakhishvili Tbilisi State University, Tbilisi, Georgia.,School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | | | - Ana Ghonghadze
- School of Medicine and Healthcare Management, Caucasus University, Tbilisi, Georgia
| | - Beka Dangadze
- School of Medicine and Healthcare Management, Caucasus University, Tbilisi, Georgia
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Ferorelli D, Solarino B, Trotta S, Mandarelli G, Tattoli L, Stefanizzi P, Bianchi FP, Tafuri S, Zotti F, Dell’Erba A. Incident Reporting System in an Italian University Hospital: A New Tool for Improving Patient Safety. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176267. [PMID: 32872189 PMCID: PMC7503737 DOI: 10.3390/ijerph17176267] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 01/05/2023]
Abstract
Clinical risk management constitutes a central element in the healthcare systems in relation to the reverberation that it establishes, and as regards the optimization of clinical outcomes for the patient. The starting point for a right clinical risk management is represented by the identification of non-conforming results. The aim of the study is to carry out a systematic analysis of all data received in the first three years of adoption of a reporting system, revealing the strengths and weaknesses. The results emerged showed an increasing trend in the number of total records. Notably, 86.0% of the records came from the medical category. Moreover, 41.0% of the records reported the possible preventive measures that could have averted the event and in 30% of the reports are hints to be put in place to avoid the repetition of the events. The second experimental phase is categorizing the events reported. Implementing the reporting system, it would guarantee a virtuous cycle of learning, training and reallocation of resources. By sensitizing health workers to a correct use of the incident reporting system, it could become a virtuous error learning system. All this would lead to a reduction in litigation and an implementation of the therapeutic doctor–patient alliance.
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Affiliation(s)
- Davide Ferorelli
- Interdisciplinary Department of Medicine, Section of Legal Medicine, University of Bari, Piazza Giulio Cesare 11, 70100 Bari, Italy; (B.S.); (S.T.); (G.M.); (F.Z.); (A.D.)
- Correspondence: ; Tel.: +39-3284138388
| | - Biagio Solarino
- Interdisciplinary Department of Medicine, Section of Legal Medicine, University of Bari, Piazza Giulio Cesare 11, 70100 Bari, Italy; (B.S.); (S.T.); (G.M.); (F.Z.); (A.D.)
| | - Silvia Trotta
- Interdisciplinary Department of Medicine, Section of Legal Medicine, University of Bari, Piazza Giulio Cesare 11, 70100 Bari, Italy; (B.S.); (S.T.); (G.M.); (F.Z.); (A.D.)
| | - Gabriele Mandarelli
- Interdisciplinary Department of Medicine, Section of Legal Medicine, University of Bari, Piazza Giulio Cesare 11, 70100 Bari, Italy; (B.S.); (S.T.); (G.M.); (F.Z.); (A.D.)
| | - Lucia Tattoli
- Città della Salute e della Scienza di Torino, Turin Hospital, 10126 Torino, Italy;
| | - Pasquale Stefanizzi
- Biomedical Science and Human Oncology, University of Bari, Piazza Giulio Cesare 11, 70100 Bari, Italy; (P.S.); (F.P.B.); (S.T.)
| | - Francesco Paolo Bianchi
- Biomedical Science and Human Oncology, University of Bari, Piazza Giulio Cesare 11, 70100 Bari, Italy; (P.S.); (F.P.B.); (S.T.)
| | - Silvio Tafuri
- Biomedical Science and Human Oncology, University of Bari, Piazza Giulio Cesare 11, 70100 Bari, Italy; (P.S.); (F.P.B.); (S.T.)
| | - Fiorenza Zotti
- Interdisciplinary Department of Medicine, Section of Legal Medicine, University of Bari, Piazza Giulio Cesare 11, 70100 Bari, Italy; (B.S.); (S.T.); (G.M.); (F.Z.); (A.D.)
| | - Alessandro Dell’Erba
- Interdisciplinary Department of Medicine, Section of Legal Medicine, University of Bari, Piazza Giulio Cesare 11, 70100 Bari, Italy; (B.S.); (S.T.); (G.M.); (F.Z.); (A.D.)
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Ravindran S, Bassett P, Shaw T, Dron M, Broughton R, Griffiths H, Keen D, Wood E, Healey CJ, Green J, Ashrafian H, Darzi A, Coleman M, Thomas-Gibson S. Improving safety and reducing error in endoscopy (ISREE): a survey of UK services. Frontline Gastroenterol 2020; 12:593-600. [PMID: 34917317 PMCID: PMC8640393 DOI: 10.1136/flgastro-2020-101561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The Joint Advisory Group on Gastrointestinal Endoscopy (JAG) 'Improving Safety and Reducing Error in Endoscopy' (ISREE) strategy was developed in 2018. In line with the strategy, a survey was conducted within the JAG census in 2019 to gain further insights and understanding of key safety-related areas within UK endoscopy. METHODS Questions were developed using the ISREE strategy as a guide and adapted by key JAG stakeholders. They were incorporated into the 2019 JAG census of UK endoscopy services. Quantitative and qualitative statistical methods were employed to analyse the results. RESULTS There was a 68% response rate. There was regional variability in the provision of out-of-hours GIB services (p<0.001). Across 1 month, 1535 incidents were reported across all services. There was a significantly higher proportion of reported incidents in acute services compared with others (p<0.001). Technical and training incidents were likely to be reported significantly differently to all other incident types. 74% of services have an endoscopy-specific sedation policy and 42% have a named sedation or anaesthetic lead for endoscopy. Services highlighted a desire for more anaesthetic-supported lists. Only 66% of services stated they have an effective strategy for supporting upskilling of endoscopists. Across acute services, 56% have access to human factors and endoscopic non-technical skills (ENTS) training. Patient feedback is used in several ways to improve services, develop training and promote shared learning among endoscopy users. CONCLUSIONS The census provides a benchmark for key safety-related characteristics of endoscopy services. These results have highlighted key areas to develop, guided by the ISREE strategy.
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Affiliation(s)
- Srivathsan Ravindran
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK,Surgery and Cancer, Imperial College London, London, London, UK
| | | | - Tim Shaw
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, London, UK
| | - Michael Dron
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, London, UK
| | - Raphael Broughton
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, London, UK
| | - Helen Griffiths
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK
| | - Dimple Keen
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK
| | - Eleanor Wood
- Gastroenterology, Homerton University Hospital NHS Foundation Trust, London, London, UK,Simulation Centre, Homerton University Hospital NHS Foundation Trust, London, London, UK
| | - Chris J Healey
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK,Gastroenterology and Hepatology Services, Airedale NHS Foundation Trust, Keighley, West Yorkshire, UK
| | - John Green
- Gastroenterology, Cardiff and Vale NHS Trust, Cardiff, Cardiff, UK
| | - Hutan Ashrafian
- Surgery and Cancer, Imperial College London, London, London, UK
| | - Ara Darzi
- Surgery and Cancer, Imperial College London, London, London, UK
| | - Mark Coleman
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK,Colorectal Surgery, University Hospitals Plymouth NHS Trust, Plymouth, Plymouth, UK
| | - Siwan Thomas-Gibson
- Surgery and Cancer, Imperial College London, London, London, UK,Wolfson Endoscopy Unit, St Mark's Hospital and Academic Institute, Harrow, London, UK
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Dhamanti I, Leggat S, Barraclough S. Practical and Cultural Barriers to Reporting Incidents Among Health Workers in Indonesian Public Hospitals. J Multidiscip Healthc 2020; 13:351-359. [PMID: 32308408 PMCID: PMC7138616 DOI: 10.2147/jmdh.s240124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/25/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This study investigated the practical and cultural barriers of reporting patient safety incidents in three accredited public hospitals in East Java, Indonesia. METHODS This study employed a mixed methods approach using a convergent parallel design. We surveyed 1121 health workers and interviewed 27 managerial staff members from the sampled hospitals. A chi-square analysis was performed to evaluate differences in demographic factors, barriers to reporting, and practices of reporting between those who had reported an incident and those who had witnessed an incident but had not reported it. NVivo 11 software was used to perform the qualitative data analysis. RESULTS This study had a 76.53% response rate. The quantitative evaluation identified significant differences in professions and work units and in participation in quality and safety training between the reporting group and the non-reporting group. The analysis of practical barriers displayed significant differences between the groups with the following responses: "did not know how to report," "did not know where to report," and "lack of feedback". For cultural barriers, a significant difference was shown only for the response "did not want conflict." In the qualitative assessment, most of the interview participants reported lack of knowledge and lack of socialization or training as practical barriers in reporting incidents. Furthermore, reluctance and fear to report were mentioned as cultural barriers by most of the interviewees. CONCLUSION Because there were conflicting findings in the barriers of reporting incidents, these barriers must be identified, discussed, and resolved by health workers and their managers or supervisors to improve incident reporting. Managers must foster open communication and build positive connections with health workers. Further research is necessary to focus on possible ways of addressing the barriers to reporting.
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Affiliation(s)
- Inge Dhamanti
- Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
- Center for Patient Safety Research, Universitas Airlangga, Surabaya, Indonesia
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Sandra Leggat
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Simon Barraclough
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
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Rich A, Viney R, Griffin A. Understanding the factors influencing doctors' intentions to report patient safety concerns: a qualitative study. J R Soc Med 2020; 112:428-437. [PMID: 31609172 DOI: 10.1177/0141076819877542] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To investigate doctors' intentions to raise a patient safety concern by applying the socio-psychological model 'Theory of Planned Behaviour'. DESIGN Qualitative semi-structured focus groups and interviews. SETTING Training venues across England (North West, South East and South West). PARTICIPANTS Sampling was purposeful to include doctors from differing backgrounds and grades. MAIN OUTCOME MEASURES Perceptions of raising a patient safety concern. RESULTS While raising a concern was considered an appropriate professional behaviour, there were multiple barriers to raising a concern, which could be explained by the Theory of Planned Behaviour. Negative attitudes operated due to a fear of the consequences, such as becoming professionally isolated. Disapproval for raising a concern was encountered at an interpersonal and organisational level. Organisational constraints of workload and culture significantly undermined the raising of a concern. Responses about concerns were often side-lined or not taken seriously, leading to demotivation to report. This was reinforced by high-profile cases in the media and the negative treatment of whistle-blowers. While regulator guidance acted as an enabler to justify raising a concern, doctors felt disempowered to raise a concern about people in positions of greater power, and ceased to report concerns due to a perceived lack of action about concerns raised previously. CONCLUSIONS Intentions to raise a concern were complex and highly contextual. The Theory of Planned Behaviour is a useful model to aid understanding of the factors which influence the decision to raise a concern. Results point to implications for policymakers, including the need to publicise positive stories of whistle-blowers and providing greater support to doctors.
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Affiliation(s)
- Antonia Rich
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London NW3 2PF, UK
| | - Rowena Viney
- Research Department of Medical Education, UCL Medical School, Royal Free Hospital, London NW3 2PF, UK
| | - Ann Griffin
- Research Department of Medical Education, UCL Medical School, London WC1E 6AU, UK
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Sendlhofer G, Schweppe P, Sprincnik U, Gombotz V, Leitgeb K, Tiefenbacher P, Kamolz LP, Brunner G. Deployment of Critical Incident Reporting System (CIRS) in public Styrian hospitals: a five year perspective. BMC Health Serv Res 2019; 19:412. [PMID: 31234858 PMCID: PMC6591923 DOI: 10.1186/s12913-019-4265-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/17/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To increase patient safety, so-called Critical Incident Reporting Systems (CIRS) were implemented. For Austria, no data are available on how CIRS is used within a healthcare facility. Therefore, the aim of this study was to present the development of CIRS within one of the biggest hospital providers in Austria. METHODS In the province of Styria, CIRS was introduced in 2012 within KAGes (holder of public hospitals) in 22 regional hospitals and one tertiary university hospital. CIRS is available in all of these hospitals using the same software solution. For reporting a CIRS case an overall guideline exists. RESULTS As of 2013, 2.504 CIRS cases were reported. Predominantly, CIRS-cases derived from surgical and associated disciplines (ranging from 35 to 45%). According to the list of hazards (also called "risk atlas"), errors in patient identification (ranging from 7 to 12%), errors in management of medicinal products (ranging from < 5 to 9%), errors in management of medical devices (ranging from < 5 to 10%) and errors in communication (ranging from < 5 to 6%) occurred most frequently. Most often, a CIRS case was reported due to individual error-related reasons (48%), followed by errors caused by organization, team factors, communication or documentation failures (34%). CONCLUSIONS In summary, CIRS has been used for 5 years and 2.504 CIRS-cases were reported. There is a steady increase of reported CIRS cases per year. It became also obvious that disregarding guidelines or standards are a very common reason for reporting a CIRS case. CIRS can be regarded as a helpful supportive tool in clinical risk management and supports organizational learning and thereby collective knowledge management.
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Affiliation(s)
- Gerald Sendlhofer
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria.
| | - Peter Schweppe
- Department for Law and Risk Management, Styrian Hospitals Limited Liability Company (KAGes), Graz, Austria
| | - Ursula Sprincnik
- Department for Law and Risk Management, Styrian Hospitals Limited Liability Company (KAGes), Graz, Austria
| | - Veronika Gombotz
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | - Karina Leitgeb
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | - Peter Tiefenbacher
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | - Lars-Peter Kamolz
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Gernot Brunner
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
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