Uncovering the Risks of Anticancer Therapy Through Incident Report Analysis Using a Newly Developed Medical Oncology Incident Taxonomy

Abstract

Background Incident reporting systems were developed to identify possible and actual harm in healthcare facilities. They have the potential to capture important safety trends and to enable improvements that can mitigate the risk of future patient harm and suffering. We recently developed and validated a taxonomy specific for medical oncology designed to enhance the identification, tracking, and trending of incidents that may lead to patient harm. The current project was designed to test the ability of such a taxonomy to be applied across different organizations delivering medical oncology care and to identify specific risks that could result in future harm. Methods We analyzed 309 randomly selected medical oncology–related incident reports from 3 different cancer centers that had been posted between January 2019 and December 2020. Each report was assigned up to 2 incident categories. We used a 2-step process to reconcile reviewer discrepancies. In a secondary analysis, each of the incidents was reviewed and recoded to identify events which may result in major or catastrophic harm. Results Three hundred four incidents met criteria for inclusion. Three hundred incidents (98.7%) were successfully coded. Sixty-seven percent of incidents were encompassed by the following 4 of 21 categories: prescriber ordering (22%), nursing care (15%), pharmacy (14%), and relational/communication issues (15%). Of 297 evaluable incidents, 47% did not reach the patient, 44.7% reached the patient without harm, 7.7% caused minor injury, and 0.7% caused severe injury or death. Submission rates by physicians varied between the 3 sites accounting for 1.7%, 10.7%, and 16.1% of reports. Secondary analysis identified 9 distinct scenarios that may result in major or catastrophic patient harm. Conclusions A medical oncology–specific incident reporting taxonomy has the potential to increase our understanding of inherent risks and may lead to process improvements that improve patient safety.

An analysis of medical malpractice claims against medical oncologists from a national database: Implications for safer practice

“…The 100‐claim sample was stratified to represent the overall mix of ambulatory and inpatient claims. The taxonomy used for safety incident coding has been described elsewhere, and is specifically developed for hematology/oncology safety incidents 16,17 . All reviewers are practicing clinicians—one hematology/oncology fellow (J.D.…”

“…We designed our study to (1) quantitatively examine the characteristics associated with malpractice claims against medical oncologists (MO) as compared to other internal medicine subspecialties (OIMS), and (2) thematically explore safety signals via coding a subset of claims using a validated medical oncology safety incident taxonomy as an organizing framework 16,17 . Our aim was to assess the framework on a set of malpractice claims that had been analyzed against a generic set of contributing factors to provide a more nuanced understanding of oncology care issues.…”