Confidential clinician-reported surveillance of adverse events among medical inpatients

BACKGROUND: Although iatrogenic injury poses a significant risk to hospital ized patients, detection of adverse events (AEs) is costly and difficult. METHODS: The authors developed a confidential reporting method for detectin g AEs on a medicine unit of a teaching hospital. Adverse events were define d as patient injuries. Potential adverse events (PAEs) represented errors t hat could have, but did not result in harm. Investigators interviewed house officers during morning rounds and by e-mail, asking them to identify obst acles to high quality care and iatrogenic injuries. They compared house off icer reports with hospital incident reports and patients' medical records. A multivariate regression model identified correlates of reporting. RESULTS: One hundred ten events occurred, affecting 84 patients. Queries by e-mail (incidence rate ratio [IRR] = 0.16; 95% confidence interval [95% CI ], 0.05 to 0.49) and on days when house officers rotated to a new service ( IRR = 0.12; 95% CI, 0.02 to 0.91) resulted in fewer reports. The most commo nly reported process of care problems were inadequate evaluation of the pat ient (16.4%), failure to monitor or follow up (12.7%), and failure of the l aboratory to perform a test (12.7%). Respondents identified 29 (26.4%) AEs, 52 (47.3%) PAEs, and 29 (26.4%) other house officer-identified quality pro blems. An AE occurred in 2.6% of admissions. The hospital incident reportin g system detected only one house officer-reported event. Chart review corro borated 72.9% of events. CONCLUSIONS: House officers detect many AEs among inpatients. Confidential peer interviews of front-line providers is a promising method for identifyi ng medical errors and substandard quality.