Reports From the Field

Attitudes of Physicians in Training Regarding Reporting of Patient Safety Events


 

References

From the Department of Internal Medicine, Advocate Lutheran General Hospital, Park Ridge, IL.

Abstract

  • Objective: To understand the attitudes and experiences of physicians in training with regard to patient safety event reporting.
  • Methods: Residents and fellows in the department of internal medicine were surveyed using a questionnaire containing 5 closed-ended items. These items examined trainees’ attitudes, experiences and knowledge about safety event reporting and barriers to their reporting.
  • Results: 61% of 80 eligible trainees responded. The majority of residents understood that it is their responsibility to report safety events. Identified barriers to reporting were the complexity of the reporting system, lack of feedback after reporting safety events to gain knowledge of system advances, and reporting was not a priority in clinical workflow.
  • Conclusion: An inpatient safety and quality committee intends to develop solutions to the challenges faced by trainees’ in reporting patient safety events.

Nationwide, graduate medical education programs are changing to include a greater focus on quality improvement and patient safety [1,2]. This has been recognized as a priority by the Institute of Medicine, the Joint Commission, and the Accreditation Council for Graduate Medical Education (ACGME) [3–6]. Hospital safety event reporting systems have been implemented to improve patient safety. Despite national expectations and demonstrated benefits of reporting adverse events, most resident and attending physicians fail to understand the value, lack the skills to report, and do not participate in incident reporting [7–9].

Past attempts to increase awareness about patient safety reporting have resulted in minimal participation [10,11]. In relation to other health care providers, attending and resident physicians have the lowest rate of patient safety reporting [12]. Interventions aiming to improve reporting have had mixed results, with sustained improvement being a major challenge [13,14]. To advance our efforts to improve reporting of patient safety events as a means toward improving patient safety, we sought to understand the attitudes and beliefs of our physicians in training with regard to patient safety event reporting.

Methods

Setting

Our institution, a community teaching hospital located in Park Ridge, IL, began patient safety event reporting in 2006 by remote data entry using the Midas information management system (MidasPlus, Xerox, Tucson, AZ). In 2012, as part of the system-based practice ACGME competency, we asked residents enter at least 1 patient safety event for each rotation block. The events could be entered with identifying information or anonymously.

Quality Improvement Project

Given the national focus on patient safety and quality improvement, as well as our organizational goal of zero patient safety events by 2020, in 2014 we formed an inpatient safety and quality committee. This committee includes the medical director of patient safety, internal medicine program director, associate program director, chief resident, fellows, residents and attending physicians. The committee was formed with the long-term objective of advancing patient safety and quality improvement efforts and to decrease preventable errors. As physicians in training are key frontline personnel, the committee decided to focus its initial short-term efforts on this group.

Questionnaire

To understand the magnitude and context of resident reporting behavior, we surveyed the residents and fellows in the department of internal medicine. The fellowships were in cardiology, gastroenterology, and hematology/oncology. The questionnaire we used contained 5 closed-ended items that examined trainees attitudes, experiences, and knowledge about incident reporting. The survey was distributed to the residents and fellows via SurveyMonkeyduring August 2014.

Results

A total of 80 eligible residents and fellows received the survey, and 49 completed it (61% response rate). Almost three-fourths of respondents indicated that they knew whose responsibility it is to report safety events. Over half indicated that they forget to make a report when the ward is busy. Over two-thirds indicated that they felt it was useful to discuss safety events. We anticipated that trainees would have concerns about disciplinary action and blame. We found that 28.5% worried about disciplinary action, but 40.8% did not. Asked whether they agree or disagree with the statement “Junior staff are often unfairly blamed for adverse incidents,” over half neither agreed nor disagreed; almost one-third disagreed, and only 16.3% agreed. Complete data on the responses are shown in Table 1 .

When asked to outline reasons for not reporting incidents, participating residents and fellows identified the complexity of reporting system, lack of feedback, lack of updates about new system changes resulting from safety event reporting,

reporting not a priority in clinical workflow, and fear of losing anonymity if safety event investigated as the most common reasons ( Table 2 ).

Discussion

This pilot study demonstrated that resident and fellow physicians in the department of internal medicine at our institution understand the necessity of reporting and that it is their responsibility; however, it is not a priority during the busy clinical workflow on the wards. Other investigators have observed similar attitudes/behaviors among physicians across teaching hospitals in the United States [10,12]. In a study by Boike et al [15], despite positive attitudes among internal medicine residents regarding reporting, increased reporting could not be sustained after the initial increase.

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