A Public Health Approach to Patient Safety Reporting Systems Is Urgently Needed

2011 ◽  
Vol 7 (2) ◽  
pp. 109-112 ◽  
Author(s):  
Douglas J. Noble ◽  
Sukhmeet S. Panesar ◽  
Peter J. Pronovost
2006 ◽  
Vol 72 (11) ◽  
pp. 1088-1091 ◽  
Author(s):  
John R. Clarke

The Institute of Medicine has recommended systems for reporting medical errors. This article discusses the necessary components of patient safety databases, steps for implementing patient safety reporting systems, what systems can do, what they cannot do, and motivations for physician participation. An ideal system captures adverse events, when care harms patients, and near misses, when errors occur without any harm. Near misses signal system weaknesses and, because harm did not occur, may provide insight into solutions. With an integrated system, medical errors can be linked to patient and team characteristics. Confidentiality and ease of use are important incentives in reporting. Confidentiality is preferred to anonymity to allow follow-up. Analysis and feedback are critical. Reporting systems need to be linked to organizational leaders who can act on the conclusions of reports. The use of statistics is limited by the absence of reliable numerators and denominators. Solutions should focus on changing the cultural environment. Patient safety reporting systems can help bring to light, monitor, and correct systems of care that produces medical errors. They are useful components of the patient safety and quality improvement initiatives of healthcare systems and they warrant involvement by physicians.


2018 ◽  
Vol 75 (6) ◽  
pp. e168-e177 ◽  
Author(s):  
Morgan M. Sellers ◽  
Ian Berger ◽  
Jennifer S. Myers ◽  
Judy A. Shea ◽  
Jon B. Morris ◽  
...  

2018 ◽  
Vol 6 (2) ◽  
pp. 83
Author(s):  
Arfella Dara Tristantia

Background: Incident reporting systems are designed to obtain information about patient safety and used for organizational and individual learning.Aims: The objective is to evaluate the implementation of patient safety incident reporting system at a hospital of Surabaya.Method: This study was an observational descriptive research supported by qualitative data. This study used Health Metrics Network (HMN) model.Results: The results of the input evaluation show that there was a policy that regulates the incident report, but its implementation was still not appropriate with no direct funding. However, facilities were provided for reporting. There were socialization for employees who have different understanding and responsibility, organizational structure of the patient safety team, problem solving method which had not used PDSA (Plan, Do, Study, Action), and computerized technology.Conclusion: The process evaluation shows that the indicators were in line with the rules. The data sources were in accordance with the guidelines. Data collection, process, presentation, and analysis were in line with the theory. The output evaluation shows the submission of incident reports had not been timely. Moreover, the report was complete and suitable to the existing guidelines, and it had been used for decision-making. It is required for the hospital to revise the guidebook of incidence reporting and improve the human resource skill.Keywords: evaluation, incident, patient safety, reporting


2007 ◽  
Vol 35 (4) ◽  
pp. 1206-1207 ◽  
Author(s):  
Bradford D. Winters ◽  
Sean M. Berenholtz ◽  
Peter Pronovost

2010 ◽  
Vol 19 (5) ◽  
pp. 440-445 ◽  
Author(s):  
J. C. Pham ◽  
E. Colantuoni ◽  
F. Dominici ◽  
A. Shore ◽  
C. Macrae ◽  
...  

2020 ◽  
Vol 203 ◽  
pp. e1256
Author(s):  
Colby P. Souders* ◽  
Kai Dallas ◽  
Falisha Kanji ◽  
Kate Cohen ◽  
Karyn S. Eilber ◽  
...  

BDJ ◽  
2016 ◽  
Vol 221 (8) ◽  
pp. 517-524 ◽  
Author(s):  
T. Renton ◽  
S. Master

2006 ◽  
Vol 21 (4) ◽  
pp. 305-315 ◽  
Author(s):  
Peter J. Pronovost ◽  
David A. Thompson ◽  
Christine G. Holzmueller ◽  
Lisa H. Lubomski ◽  
Todd Dorman ◽  
...  

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