Review of the Australian Incident Monitoring System

Spigelman, Allan D.; Swan, Judith

doi:10.1111/j.1445-2197.2005.03482.x

Cited by 47 publications

(44 citation statements)

References 20 publications

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“…Nevertheless, CIRS was found to have a positive impact on safety culture in most cases, although description or analysis of the factual relationship between the reporting system and patient safety remains vague. When applied in an optimized manner, CIRS induces positive changes such as the adaption of processes [20,53], awareness of risk [10,16,19,53], and 'near misses' [19,20]. …”

Section: Resultsmentioning

confidence: 99%

“…Several factors detrimental to a well-functioning CIRS can be identified: work overload (a higher workload has a negative effect on safety [39] and/or time pressure [7]), untrained staff (ignorance or lack of knowledge amongst staff members) [5,13,17,40], lack of feedback, lack of communication and/or team work [17], a poor quality of incident reports (inconclusive statements or too generic data) [9,10], and the collection of incident reports without an in-depth analysis [11]. During the implementation phase of a reporting system, resentments amongst staff members which affect the acceptance of CIRS might arise [41].…”

Section: Obstructive and Assisting Aspectsmentioning

confidence: 99%

“…It was found that a high incident-reporting rate correlates with a sound error and safety culture [8]. Another problem is the quality and validity of the incidents reports: CIRS indices are often skewed and ambiguous [9] or the information is often too generic [10]. To collect incident reports without in-depth analysis does not lead to a higher level of patient safety [11].…”

Section: What Was Reported?mentioning

confidence: 99%

“…Therefore, an effective error management has to be implemented in addition to the CIRS system. In two studies, acquisition of new equipment, improvements in medication and administration, adoption of novel standards, and training programs amongst other measures were implemented as a result of incident reports [10,37]. The training of staff was recommended by most authors.…”

Section: Documented Improvement Actionmentioning

confidence: 99%

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Critical Incident Reporting System (CIRS): a fundamental component of risk management in health care systems to enhance patient safety

Petschnig

Haslinger-Baumann

2017

Saf Health

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Background: The complexity of health care systems, the development of clinical approaches, and both scientific and technological advancements give rise to new requirements in clinical risk management. An expedient risk management is expected to deal with as many risks as possible to ensure patient safety. A prerequisite for a clinical risk management is a well-functioning error-reporting culture in health care organizations. The present study analysed the relationship between the Critical Incident Reporting System (CIRS) and patient safety. In particular, the aim of this work is to evaluate whether data from available sources provide sufficient evidence for the utility of CIRS and to derive recommendations for both theorists and practitioners. On paper, CIRS is expected to be useful in clinical settings because it allows the identification of weak spots, hazards, and critical situations such as 'near misses'. However, neither a general CIRS database based on clinical reports exists nor a universal CIRS policy or CIRS direction has been established so far, which can be attributed to the inhomogeneity of the literature and the variability of approaches. Therefore, ordering and analysis of clinical reports are highly desirable. Methods: First, inclusion criteria, exclusion criteria, and keywords were defined to collect studies, reviews, and other sources on CIRS from official databases. After the collection of appropriate articles, a description of the individual data is given. Then, data are classified into different sections based on their respective central statements, and a brief description is given. Finally, the reports are analysed in order to detect patterns and differences. Results: There is a close correlation between the establishment of CIRS in a health care organization and patient safety, although a quantitative relationship between reporting systems and safety is still unproven. CIRS allows the identification and implementation of appropriate actions and strategies toward patient safety. Several prerequisites were identified: top management commitment, transparency, training, anonymity, incentives, and an open error-reporting culture. Personnel have an important impact on the reduction of risk and on the development of safety. The leadership should accept the implementation of a "no blame" error and feedback culture and the security of an absolutely anonymous reporting system. The position of a risk or safety manager is highly recommended. Conclusion: As immediate recommendations, health care organizations are encouraged to adopt CIRS. On the other hand, several research topics were identified, such as the quantitative relationship between CIRS and safety or the development of reliable incident-reporting indices and the ways on how to deal with them. Intensified empirically based research may help in answering open questions concerning CIRS.

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Section: Resultsmentioning

confidence: 99%

Section: Obstructive and Assisting Aspectsmentioning

confidence: 99%

Section: What Was Reported?mentioning

confidence: 99%

Section: Documented Improvement Actionmentioning

confidence: 99%

See 2 more Smart Citations

Critical Incident Reporting System (CIRS): a fundamental component of risk management in health care systems to enhance patient safety

Petschnig

Haslinger-Baumann

2017

Saf Health

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“…A research agenda to address these problems should include building a patient safety ontology, where a uniform knowledge base for representing patient safety knowledge is in the center of the discussion (Chang et al, 2005 (Brixey, Johnson, & Zhang, 2002;Chang et al, 2005;Dovey et al, 2002;Greens, 2006;Spigelman & Swan, 2005;Suresh et al, 2004;Woods & Doan-Johnson, 2002;Woods et al, 2005;Zhang et al, 2004). Nevertheless, ontology is recognized as an advanced solution for providing machinereadable representations for semantic information (Allemang & Hendler, 2011;Ananiadou & McNaught, 2006;Maynard, Li, & Peters, 2008;McGuinness et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

Knowledge Representation in Patient Safety Reporting: An Ontological Approach

Liang

Gong

2016

Journal of Data and Information Science

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Purpose: The current development of patient safety reporting systems is criticized for loss of information and low data quality due to the lack of a uniformed domain knowledge base and text processing functionality. To improve patient safety reporting, the present paper suggests an ontological representation of patient safety knowledge.Design/methodology/approach: We propose a framework for constructing an ontological knowledge base of patient safety. The present paper describes our design, implementation, and evaluation of the ontology at its initial stage. Findings:We describe the design and initial outcomes of the ontology implementation. The evaluation results demonstrate the clinical validity of the ontology by a self-developed survey measurement. Research limitations:The proposed ontology was developed and evaluated using a small number of information sources. Presently, US data are used, but they are not essential for the ultimate structure of the ontology. Practical implications:The goal of improving patient safety can be aided through investigating patient safety reports and providing actionable knowledge to clinical practitioners. As such, constructing a domain specific ontology for patient safety reports serves as a cornerstone in information collection and text mining methods.Originality/value: The use of ontologies provides abstracted representation of semantic information and enables a wealth of applications in a reporting system. Therefore, constructing such a knowledge base is recognized as a high priority in health care.

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Active involvement of nursing staff in reporting and grading complication‐intervention events—Protocol and results of the CAMUS Pilot Nurse Delphi Study

et al. 2022

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Objectives: The aim of this study is to gain experienced nursing perspective on current and future complication reporting and grading in Urology, establish the CAMUS CCI and quality control the use of the Clavien-Dindo Classification (CDC) in nursing staff. Subjects and Methods:The 12-part REDCap-based Delphi survey was developed in conjunction with expert nurse, urologist and methodologist input. Certified local and international inpatient and outpatient nurses specialised in urology, perioperative nurses and urology-specific advanced practice nurses/nurse practitioners will be included. A minimum sample size of 250 participants is targeted. The survey assesses participant demographics, nursing experience and opinion on complication reporting and the proposed CAMUS reporting recommendations; grading of intervention events using the existing CDC and the proposed CAMUS Classification; and rating various clinical scenarios. Consensus will be defined as ≥75% agreement. If consensus is not reached, subsequent Delphi rounds will be performed under Steering Committee guidance.Results: Twenty participants completed the pilot survey. Median survey completion time was 58 min . The survey revealed that 85% of nursing participants believe nurses should be involved in future complication reporting and grading but currently have poor confidence and inadequate relevant background education.Overall, 100% of participants recognise the universal demand for reporting consensus and 75% hold a preference towards the CAMUS System. Limitations include variability in nursing experience, complexity of supplemental grades and survey duration.

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Review of the Australian Incident Monitoring System

Cited by 47 publications

References 20 publications

Critical Incident Reporting System (CIRS): a fundamental component of risk management in health care systems to enhance patient safety

Critical Incident Reporting System (CIRS): a fundamental component of risk management in health care systems to enhance patient safety

Knowledge Representation in Patient Safety Reporting: An Ontological Approach

Active involvement of nursing staff in reporting and grading complication‐intervention events—Protocol and results of the CAMUS Pilot Nurse Delphi Study

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