Background: Error reporting is an integral component in the safety program of hospitals. Residents in training programs are encouraged and expected to participate in error reporting as part of the clinical learning environment. Previous studies identified barriers to resident reporting including knowledge of how to submit reports and understanding how reports affect institutional safety culture. We undertook a QI initiative to address these two barriers with the aim of increasing error reporting among residents.
Purpose: At an urban tertiary care academic hospital, a QI project was implemented with the aim of increasing resident error reporting in the Department of Medicine. Using Plan-Do-Study-Act (PDSA) methodology, education and feedback interventions were implemented by chief residents. The first set of interventions implemented regular reminders and education on how to report errors. The second intervention involved implementation of a feedback program called “Close-The-Loop” to inform residents on outcomes of investigations on reported safety events and any relevant safety solutions. Error reporting by Medicine residents was tracked through the hospital’s electronic error reporting system. During our study period, the electronic system migrated from a program called MERS to an electronic program DATIX in December 2020. Both systems allowed the reporter to remain anonymous or share their identity and/or clinical role. Data on resident error reporting was captured by screening electronic submissions in which reporters self-identified as residents in the Department of Medicine.
Description: Baseline data from January-November 2020 demonstrated 35 events reported by Medicine residents, a rate of 3.2 events per month. In December 2020, a new electronic error reporting system was implemented. Onboarding and education on the use of the new platform were provided to residents in December 2020. Reporting from January to March remained stagnant with 2-4 events reported per month despite implementation of the new system (figure 1). Starting in April, emails by chief residents to remind housestaff on the use of the electronic error reporting system was sent regularly. In July, instruction on how to submit error reports was included in the chief orientation at the beginning of each resident block rotation, and in August, the Close-the-Loop program was implemented. From January-November 2020, 86 events were reported by residents, a rate of 7.8 events reported per month and represented a significant increase from baseline (p=0.02). Resident reports were categorized (figure 2) and among the errors most commonly reported were treatment delay (21.8%), communication (20.7%), triage (19.5%), monitoring (9.2%) and handoff (8.0%).
Conclusions: In this QI initiative, we showed an increase in resident error reporting from 3.2 events per month in 2019 to 7.8 events per month in 2020 using ongoing education and informing residents on the outcomes of safety investigations for errors they reported. Residents frequently escalate concerns to chief residents, so a peer education system led by the chief residents may be more impactful in encouraging error reporting. Building this education in existing onboarding and education forums including rotation orientation and conferences ensure intervention continuity. Additionally, providing residents feedback about the outcomes of safety investigations for incidents they report allows them to understand the positive impact of their reporting and encourage future reporting.