A Comprehensive Overview of Medical Error in Hospitals Using Incident-Reporting Systems, Patient Complaints and Chart Review of Inpatient Deaths

Jeantine M De Feijter,Arno M Muijtjens,Albert J J A Scherpbier,Richard P Koopmans,Willem S De Grave,Daniel Morgan

doi:10.1371/journal.pone.0031125

Jeantine M De Feijter, Arno M Muijtjens + Show 4 more

Open Access

https://doi.org/10.1371/journal.pone.0031125

Copy DOI

Abstract

BackgroundIncident reporting systems (IRS) are used to identify medical errors in order to learn from mistakes and improve patient safety in hospitals. However, IRS contain only a small fraction of occurring incidents. A more comprehensive overview of medical error in hospitals may be obtained by combining information from multiple sources. The WHO has developed the International Classification for Patient Safety (ICPS) in order to enable comparison of incident reports from different sources and institutions.MethodsThe aim of this paper was to provide a more comprehensive overview of medical error in hospitals using a combination of different information sources. Incident reports collected from IRS, patient complaints and retrospective chart review in an academic acute care hospital were classified using the ICPS. The main outcome measures were distribution of incidents over the thirteen categories of the ICPS classifier “Incident type”, described as odds ratios (OR) and proportional similarity indices (PSI).ResultsA total of 1012 incidents resulted in 1282 classified items. Large differences between data from IRS and patient complaints (PSI = 0.32) and from IRS and retrospective chart review (PSI = 0.31) were mainly attributable to behaviour (OR = 6.08), clinical administration (OR = 5.14), clinical process (OR = 6.73) and resources (OR = 2.06).ConclusionsIRS do not capture all incidents in hospitals and should be combined with complementary information about diagnostic error and delayed treatment from patient complaints and retrospective chart review. Since incidents that are not recorded in IRS do not lead to remedial and preventive action in response to IRS reports, healthcare centres that have access to different incident detection methods should harness information from all sources to improve patient safety.

Highlights

It has been increasingly recognised that hospitals can be dangerous places for patients, since medical errors have been shown to cause harm to patients [1,2]
If Incident reporting systems (IRS) do not capture all types of error and if action to address errors is based on IRS reports, patient safety may not be served optimally
Incident reports vs. patient complaints Figure 1 shows a substantial difference between the distributions of incident reports (IR) and patient complaints (PC), with a low proportional similarity indices (PSI) of 0.32

Summary

Introduction

It has been increasingly recognised that hospitals can be dangerous places for patients, since medical errors have been shown to cause harm to patients [1,2]. In order to identify medical errors, to learn from mistakes and to improve patient safety, the healthcare community has introduced incident reporting systems (IRS) [2]. As IRS are based on voluntary reporting a non-punitive environment has to be present in hospitals to generate high reporting rates [2] That this type of environment is difficult to achieve may be reflected in the fact that IRS have been reported to reveal only the tip of the iceberg of incidents [2,4,5], estimated at 10% at most [6]. Incident reporting systems (IRS) are used to identify medical errors in order to learn from mistakes and improve patient safety in hospitals. The WHO has developed the International Classification for Patient Safety (ICPS) in order to enable comparison of incident reports from different sources and institutions

Objectives

Methods

Results

Discussion

Conclusion