Background: Incident reporting systems are widely utilized to detect adverse events and remain central to many hospital patient safety programs. It is well established that non-physicians file the majority of incident reports, but the barriers to physician reporting are not well understood. Therefore the aims of this study are to understand physicians’ perceived barriers to adverse event reporting and perceptions of adverse event review processes.
Methods: We compiled a list of faculty physicians at a single academic medical center from the departments of medicine, surgery and pediatrics. We developed a 21-item survey asking about experiences with adverse events, barriers to filing incident reports, perceptions of adverse event review processes and suggestions for improvement. We administered the anonymous survey through an electronic platform. We compared survey responses from physicians within each department using chi-square tests. Free text comments were analyzed using content analysis.
Results: We received 307 responses from 1046 medical, surgical and pediatric physicians surveyed (29.3% response rate). Over 80% of those responding across three departments reported caring for a patient who experienced an adverse event (Table 1). Roughly one-third of respondents from medicine and surgery reported an adverse event or near miss through the incident reporting system compared to almost one-half of those from pediatrics (p=0.09). Barriers to reporting that were common across disciplines included not knowing how and that reporting took too long. Surgeons were significantly more likely to state that reporting would not make a difference to patient safety as compared to physicians in medicine and pediatrics (p=0.03). Free text comments noted that the reporting system interface is not user-friendly and that findings are not consistently fed back to providers. Suggestions for improvement included increasing awareness of reporting systems and education about the importance of reporting, enhancing system usability, and providing clarification as to who is responsible for reporting. The majority of physicians reported participating in an adverse event review process and felt most comfortable talking about the situation with a peer. Free text comments suggest that some adverse event review processes continue to be perceived as punitive.
Conclusions: Physicians continue to experience barriers when reporting adverse events and near misses through incident reporting systems. Improving user interface design, providing education about how and what to report, delivering timely feedback on reports filed and ensuring that adverse event review processes maintain a blame-free environment may facilitate higher rates of physician reporting.