Physician perception of hospital safety and barriers to incident reporting

Joint Commission Journal on Quality and Patient Safety

Volumn 32, Issue 6, 2006, Pages 337-343

  Schectman, Joel M ^a   Plews Ogan, Margaret L ^a  

^a UNIVERSITY OF VIRGINIA   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; DOCUMENTATION; DRUG SURVEILLANCE PROGRAM; HEALTH CARE QUALITY; HUMAN; MEDICAL SCHOOL; MEDICAL STAFF; ORGANIZATION AND MANAGEMENT; SAFETY; STATISTICS; UNIVERSITY HOSPITAL;

ADVERSE DRUG REACTION REPORTING SYSTEMS; DOCUMENTATION; FACULTY, MEDICAL; HOSPITALS, UNIVERSITY; HUMANS; MEDICAL STAFF, HOSPITAL; QUALITY ASSURANCE, HEALTH CARE; SAFETY;

EID: 33745456679     PISSN: 15537250     EISSN: None     Source Type: Journal    
DOI: 10.1016/S1553-7250(06)32043-0     Document Type: Article

References (29)

1. Institute of Medicine: To Err Is Human: Building a Safer Health System. Washington, D.C.: National Academy Press, 1999.
2. Leape L.L., Berwick D.M.: Safe health care: Are we up to it? BMJ 320:725-726, Mar. 18, 2000.
3. Berwick D.M.: Errors today and errors tomorrow. N Engl J Med 348:2570-2572, Jun. 19, 2003.
4. Leape L.L., Berwick D.M.: Five years after To Err Is Human: What have we learned? JAMA 293:2384-2390, May 18, 2005.
5. Amalberti R.: Five system barriers to achieving ultrasafe health care. Ann Intern Med 142:756-764, May 3, 2005.
6. Reason J.: Managing the Risks of Organizational Accidents. Aldershot, U.K.: Ashgate Publishing, 1997.
7. Hoff T.J., Pohl H., Bartfield I.: Implementing safety cultures in medicine: What we learn by watching physicians. In Henriksen K., et al. (eds.): Advances in Patient Safety: From Research to Implementation, vol 1. Rockville, MD: Agency for Healthcare Research and Quality, 2005, pp. 15-38. http://www.ahrq.gov/downloads/pub/advances/vol1/Hoff.pdf (last accessed Apr. 13, 2006).
8. Cullen D.J., et al.: The incident reporting system does not detect adverse drug events: A problem for quality improvement. Jt Comm J Qual Improv 21:541-548, Oct. 1995.
9. Flynn E.A., et al.: Comparison of methods for detecting medication errors in 36 hospitals and skilled nursing facilities. Am J Health Syst Pharm 59:436-446, Mar. 2002.
10. Allan E.L., Barker K.N.: Fundamentals of medication error research. Am J Hosp Pharm 47:555-571, Mar. 1990.
11. Nguyen Q.T., Weinberg J., Hilborne L.H.: Physician event reporting: Training the next generation of physicians. In Henriksen K., et al. (eds.): Advances in Patient Safety: From Research to Implementation, vol 4. Rockville, MD: Agency for Healthcare Research and Quality, pp. 353-360. http://www.ahrq.gov/downloads/pub/advances/vol4/Nguyen.pdf (last accessed Apr. 13, 2006).
12. Lawton R., Parker D.: Barriers to incident reporting in a healthcare system. Qual Saf Health Care 11:15-18, Mar. 2002.
13. Robinson A.R., et al.: Physician and public opinions on quality of health care and the problems of medical errors. Arch Intern Med 162:2186-2190, Oct. 18, 2002.
14. Taylor J.A., et al.: Use of incident reports by physicians and nurses to document medical errors in pediatric patients. Pediatrics 114:729-735, Sep. 2004.
15. Vincent C., et al.: Reasons for not reporting adverse incidents: An empirical study. J Eval Clin Pract 5:14-21, Feb. 1999.
16. Leape L.L.: Why should we report adverse incidents? J Eual Clin Pract 5:1-4, Feb. 1999.
17. Grzybicki D.M.: Barriers to the implementation of patient safety initiatives. Clin Lab Med 24:901-911, Dec. 2004.
18. Agency for Healthcare Research and Quality: Update on Hospital Survey on Patient Safety Culture Database, http://www.ahrq.gov/qual/hospculture/ (last accessed Apr. 13, 2006).
19. Hofer T.P., Hayward R.A.: Are bad outcomes from questionable clinical decisions preventable medical errors? A case of cascade iatrogenesis. Ann Intern Med 137:327-333, Sep. 3, 2002.
20. Hayward R.A., Hofer T.P.: Estimating hospital deaths due to medical errors: Preventability is in the eyes of the reviewer. JAMA 286:415-420, Jul. 25, 2002.
21. Runciman W.B., et al.: Error, blame, and the law in health care: An antipodean perspective. Ann Intern Med 138:974-979, Jun. 17, 2003.
22. Plews-Ogan M.L., et al.: Patient safety in the ambulatory setting: A clinician-based approach. J Gen Intern Med 19:719-725, Jul. 2004.
23. O'Neil A.C.: Physician reporting compared with medical-record review to identify adverse medical events. Ann Intern Med 119:363-370, Sep. 1, 1993.
24. Chaudhry S.I., Olofinboba K.A., Krumholz H.M.: Detection of errors by attending physicians on a general medicine service. J Gen Intern Med 18:595-600, Aug. 2003.
25. Weingart S.N., Ship A.N., Aronson M.D.: Confidential clinicianreported surveillance of adverse events among medical inpatients. J Gen Intern Med 15:470-477, Jul. 2000.
26. Welsh C.H., Pedot R.P., Anderson R.J.: Use of morning report to enhance adverse event detection. J Gen Intern Med 11:454-460, Aug. 1996.
27. Wachter R.M.: The end of the beginning: Patient safety five years after 'to err is human'. Health Aff (Millwood) Suppl. Web Exclusives: W4-534-W4-545, Jul.-Dec. 2004.
28. Barach P., Berwick D.M.: Patient safety and the reliability of health care systems. Ann Intern Med 138:997-998, Jun. 17, 2003.
29. Agency for Healthcare Research and Quality: Hospital Surrey on Patient Safety Culture. Comparing Your Results: Preliminary Benchmarks. http://www.ahrq.gov/qual/hospculture/prebenchmk.htm (last accessed Apr. 13, 2006).