USE OF MORNING REPORT TO ENHANCE ADVERSE EVENT DETECTION

OBJECTIVE: To determine whether or not prompting of medical residents at morning report enhances reporting of adverse events in hospitalized patients. DESIGN: Prospective trial comparing 3-month blocks of inten sive prompting, modest prompting, and no prompting on adverse event re porting by housestaff at morning report. SETTING: Inpatient internal m edicine service at a university-affiliated, Veterans Affairs Medical C enter teaching hospital, INTERVENTIONS: Intensive prompting (daily), m odest prompting (once or twice weekly), and no prompting of medical re sidents to report hospital-associated adverse events. MEASUREMENTS AND MAIN RESULTS: The number, type, and severity of hospital-acquired adv erse events occurring on an internal medicine service were determined during the various periods of intervention on a per houseofficer basis . Residents were reminded to record events once or twice weekly, daily , or not at all, These data were compared with those identified by usu al hospital surveillance. The addition of housestaff reporting to usua l hospital surveillance increased the numbers of adverse events report ed. There was little overlap in episodes reported by the two strategie s. Increasing the level of prompting increased the number of reports p er houseofficer. Housestaff prompting increased reporting at all level s of adverse event severity from mild to serious and detected a wide v ariety of types of adverse events, especially adverse drug reactions a nd procedure complications. CONCLUSIONS: Our study demonstrates that p hysician self-reporting of adverse events adds to the usual hospital s urveillance adverse event reporting, and finds that such reporting can be easily accomplished within the context of a daily teaching activit y. The information provided about adverse events by housestaff at morn ing report is additive to that obtained by usual surveillance methods. The use of such a strategy provides information in a timely fashion.