Interventions to increase clinical incident reporting in health care

Abstract

Background Reporting of adverse clinical events is thought to be an effective method of improving the safety of healthcare. Underreporting of these adverse events is often said to occur with consequence of missing of opportunities to learn from these incidents. A clinical incident can be defined as any occurrence which is not consistent with the routine care of the patient or the routine operation of the institution. Objectives To assess the effects of interventions designed to increase clinical incident reporting in healthcare settings. Search methods We searched the the following databases: Cochrane Effective Practice and Organisation of Care Group Specialised Register, the Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (OVID), EMBASE (OVID), CINAHL (EBSCO), Social Science Citation Index and Science Citation Index (Web of Knowledge), Healthstar (OVID), INSPEC, DHSS-DATA, SIGLE, ISI Conference Proceedings, Web of Science Conference Proceedings Citation Index (Science), Database of Abstracts of Reviews of Effectiveness (DARE). Selection criteria Randomised controlled trials (RCT), controlled before-after studies (CBA) and interrupted time series (ITS) of interventions designed to increase clinical incident reporting in healthcare. Data collection and analysis At least two review authors assessed the eligibility of potentially relevant studies, extracted the data and assessed the quality of included studies. Main results Four studies (one CBA and three ITS studies) met our inclusion criteria and were included in the review. The CBA study showed a significant improvement in incident reporting rates after the introduction of the new reporting system. Just one of the ITS studies showed a statistically significant improved effectiveness of the new reporting system from nine months. The other two studies reported no statistically significant improvements. Authors’ conclusions Because of the limitations of the studies it is not possible to draw conclusions for clinical practice. Anyone introducing a system into practice should give careful consideration to conducting an evaluation using a robust design.

The impact of a standardized incident reporting system in the perioperative setting: a single center experience on 2,563 `near-misses¿ and adverse events

“…emergency scenario), time constraints, unfamiliarity with the system, problems with the definitions of what constitutes a reportable incident or near-incident, lack of a hospital policy of 'no disciplinary action' on incident reporting, lack of anonymity, lack of feedback and confusing aims of the reporting system as such [13,18]. However, the best policy to improve reporting behaviour is currently unknown [39]. Unfortunately, because of the risk of under-reporting, voluntary incident reporting is not a reliable instrument to monitor performance in e.g.…”

National critical incident reporting systems relevant to anaesthesia: a European survey

“…Incident reporting had its origins in military aviation, 22 but was adopted into safety-critical industries in the second half of the 20th century. Anaesthesiology was the first specialty to make use of the technique in clinical care and, although the few randomized trials to investigate the effect of incident reporting in healthcare generally have not suggested great benefit, 23 it has been well received in our specialty. 24 The narrative element makes incident reports accessible and memorable, 25 and the potential for improving the safety and quality of care seems self-evident.…”

Evidence gap map of performance measurement and management in primary care delivery systems in low- and middle-income countries – Study protocol

“…In this category, the study identified 8 interventions of relevance including: 1) In-service training , a form of positive behavior support aimed at increasing the capabilities of individual primary care system actors 49 ; 2) Reminders , manual or computerized interventions that prompt individual providers to perform an action during a clinical exchange and can include, among others, job aids, paper reminders, checklists, and computer decision support systems 42 50 54 ; 3) Clinical practice guidelines , or systematically developed statements to assist healthcare providers and patients to decide on appropriate health care for specific circumstances 42 55 59 ; 4) Continuous education, referring to courses, workshops, or other educational meetings aimed at increasing the technical competencies of primary care providers; 5) Clinical incident reporting, or systems for reporting critical incidents and adverse or undesirable effects as a means to improving the safety of healthcare delivery 33 ; 6) Local opinion leaders , referring to the identification and use of identifiable local opinion leaders to promote good clinical practices 31 60 ; 7) Continuous quality improvement defined as the iterative process to review and improve care that includes involvement of healthcare teams, analysis of a process or system, a structured process improvement method or problem-solving approach, and use of data analysis to assess changes 42 . It will include lean management as one of the approaches used to improve efficiency and quality in service provider organizations 61 65 ; and, 8) Supervision , defined as routine control visits by senior primary care staff to providers and facilities 66 72 .…”