Factors Influencing the Reporting of Adverse Perioperative Outcomes to a Quality Management Program

Abstract

Physician self-reporting is a more reliable method of identifying adverse outcomes than either medical chart review or incident reporting. Reporting by chart reviewers is biased both by the severity of outcome and severity of patient illness, whereas incident reports tend to focus on human error. All groups feel compelled to report adverse outcomes when the data may result in improved patient care.

Factors influencing nurses? decisions to raise concerns about care quality

“…Factors identified as impeding nurses' decisions to raise concerns were concordant with those recognized in the patient safety literature as barriers to incident reporting (Runciman et al 1998, Vincent et al 1999, Katz & Lagasse 2000, Coles et al 2001, Lawton & Parker 2002. Nurses in this study expressed lack of confidence in the organizational system, which was coupled with a prediction that little or nothing would be done about raised concerns.…”

The incidence and risk factors for cardiac arrest during emergency tracheal intubation: A justification for incorporating the ASA Guidelines in the remote location

“…Despite my attempts to verify the accuracy of the recorded information via the post-procedure questionnaire, a major concern with any spontaneous reporting system is underreporting. 28,29 Self-reporting of adverse events is often limited by the recognition of the adverse event, the care provider's tendency to minimize the importance of such an event, or fear of any consequences that may result from the reporting of one's own complications. [28][29][30][31] The 2% cardiac arrest rate is at best a "rough guess" but, based on reporting tendencies, the underreporting of this critical event is probably the rule rather than the exception.…”

Intraoperative reported adverse events in children

“…Concomitant with the implementation of these guidelines, there has been a significant decrease in reported AE incidences in NORA locations in children over the past decade from 20-90% to 0.5-15% (4)(5)(6)(7)10,11,17,18) along with a decrease in the severity of adverse long term outcomes (4)(5)(6)(7)10,11,17,18). While there have been numerous anecdotal reports (7,8,12) suggesting that NORA may be associated with a higher incidence of reported AE compared to operating room anesthesia (ORA), there has been no study, so far, presenting incidence of reported AE in pediatric patients for NORA and ORA locations using the same AE monitoring system (19,20). Furthermore there is no study, so far, presenting AE incidence in children for NORA and ORA locations when the provision of anesthesia is consistent across locations with respect to pre, intra and postprocedural anesthesia care protocols, monitoring, equipment, personnel, and supervision (5)(6)(7)(8)10).…”