Reports From the Field

Improved Safety Event Reporting in Outpatient, Nonacademic Practices with an Anonymous, Nonpunitive Approach

Journal of Clinical Outcomes Management. 2015 February;22(2)

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We also compared the classification and types of safety events reported for each of 3 groups for the year April 2013 through March 2014 ( Figures 3 and 4 ; see Appendix for definitions of safety event types and classifi-cation). In the collaborative group, 88% of events reported were near miss events and precursor safety events. Only 12% were non-safety events, as compared with 65% for comparator practices and 63% for all others. Two serious safety events were reported in the “all other practices” group. Too few events occurred in the pre-intervention collaborative group to make meaningful pre- and post-intervention comparisons.

A different pattern of event type was seen for the collaborative group. Falls accounted for only 6% and diagnostic testing (16%) and communications issues (34%) totaled 50%. In contrast, for comparator practices, falls accounted for 51% of reported safety events and only 3% of events were reported as diagnostic testing (2%) and communication issues (1%). This pattern accounts for the marked differences in event classification, as falls are usually classified as non-safety events.

Discussion

In our nonacademic community practices, patient safety reporting rates improved following an initial educational session stressing anonymous, voluntary safety event reporting together with monthly audit and feedback. Our findings corroborate those of others in academic ambulatory settings, who found that an emphasis on patient safety reporting, particularly if an anonymous approach is taken in a nonpunitive atmosphere, can significantly increase the reporting of patient safety events [14–16]. We demonstrated marked under-reporting and stability of patient safety event reporting throughout our ambulatory practice group and a 10-fold increase in reporting among the 6-practice collaborative.

An unexpected finding was that with the exception of 1 practice, we found no increased reporting in comparator practices that had a patient safety coach. Additionally, we noted that general surgery practices report (or experience) very few ambulatory safety events, as a total of 4 events were reported for all 4 general surgery practices in 18 months.

We chose a quasi-experimental with a comparison group and pre-test/post-test design since randomization of practices was not feasible [17]. We used a 2-year period to control for any seasonal trends and to allow time after the intervention to see if meaningful improvement in reporting over time would continue. We attempted to address the potential for nonequivalence in the comparison group by matching for specialty and size of practice.

There are several limitations to this study. Bias in the selection of collaborative practices may have occurred since each had a proven leader, and this may have led to more rapid adoption and utilization of this reporting approach. Also, our findings may not be generalizable to other integrated health systems given the unique approaches to patient safety culture development and the disparate nature of reporting systems. In addition, with our study design we could not be certain that anonymous reporting was a key factor in the increase in reporting rates, but de-briefing interviews indicated that both anonymous reporting and declaring a nonpunitive, supportive approach in each practice was important to enhanced reporting.