Reasons for not reporting adverse incidents: an empirical study

A previous study (Stanhope et al. 1998) established that staff in two obste tric units reported less than a quarter of designated incidents to the unit s' risk managers. A questionnaire was administered to 42 obstetricians and 156 midwives at the same:two Obstetric units, exploring the reasons for low rates of reporting. Questions concerned their knowledge of their unit's in cident reporting system; whether they would report a series of 10 designate d adverse obstetric incidents to the risk manager; and their views on 12 po tential reasons for not reporting incidents. Most staff knew about the inci dent-reporting system in their unit, but almost 30% did not know how to fin d a list of reportable incidents. Views on the necessity of reporting the 1 0 designated obstetric incidents varied considerably. For example, 96% of s taff stated they would always report a maternal death, whereas less than 40 % would report a baby's unexpected admission to the Special Care Baby Unit. Midwives said they were more likely to report incidents than doctors, and junior staff were more likely to report than senior staff. The main reasons for not reporting were fears that junior staff would be blamed, high workl oad and the belief (even though the incident was designated as reportable) that the circumstances or outcome of a particular case did not warrant a re port. Junior doctors felt less supported by their colleagues than senior do ctors. Current systems of incident reporting, while providing some valuable information, do not provide a reliable index of the rate of adverse incide nts. Recommended measures to increase reliability include clearer definitio ns of incidents, simplified methods of reporting, designated staff to recor d incidents and education, feedback and reassurance to staff about the natu re and purpose of such systems.