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Research Article

Can Patient Safety Incident Reports Be Used to Compare Hospital Safety? Results from a Quantitative Analysis of the English National Reporting and Learning System Data

• Ann-Marie Howell,
• Elaine Yard. Burns,
• George Bouras,
• Liam J. Donaldson,
• Thanos Athanasiou,
• Ara Darzi

x

• Published: December 9, 2015
• https://doi.org/ten.1371/periodical.pone.0144107

Figures

Abstract

Background

The National Reporting and Learning System (NRLS) collects reports about patient rubber incidents in England. Authorities regulators use NRLS data to assess the safety of hospitals. This study aims to examine whether almanac hospital incident reporting rates can be used as a surrogate indicator of individual hospital safety. Secondly assesses which hospital characteristics are correlated with high incident reporting rates and whether a high reporting hospital is safer than those lower reporting hospitals. Finally, it assesses which wellness-care professionals report more incidents of patient harm, which report more well-nigh miss incidents and what hospital factors encourage reporting. These findings may advise methods for increasing the utility of reporting systems.

Methods

This study used a mix methods approach for assessing NRLS information. The data were investigated using Pareto analysis and regression models to constitute which patients are nearly vulnerable to reported impairment. Hospital factors were correlated with institutional reporting rates over one year to examine what factors influenced reporting. Staff survey findings regarding infirmary condom culture were correlated with reported rates of incidents causing damage; no harm and death to understand what barriers influence error disclosure.

Findings

v,879,954 incident reports were collected from astute hospitals over the decade. 70.3% of incidents produced no impairment to the patient and 0.nine% were judged by the reporter to have caused severe harm or decease. Obstetrics and Gynaecology reported the most no harm events [OR 1.61(95%CI: 1.12 to 2.27), p<0.01] and pharmacy was the infirmary location where well-nigh about-misses were captured [OR 3.03(95%CI: 2.04 to 4.55), p<0.01]. Clinicians were significantly more likely to report death than other staff [OR iii.04(95%CI: 2.43 to 3.eighty) p<0.01]. A college ratio of clinicians to beds correlated with reduced charge per unit of harm reported [RR = -ane.78(95%Cl: -3.33 to -0.23), p = 0.03]. Litigation claims per bed were significantly negatively associated with incident reports. Patient satisfaction and mortality outcomes were not significantly associated with reporting rates. Staff survey responses revealed that keeping reports confidential, keeping staff informed about incidents and giving feedback on rubber initiatives increased reporting rates [r = 0.26 (p<0.01), r = 0.17 (p = 0.04), r = 0.23 (p = 0.01), r = 0.twenty (p = 0.02)].

Conclusion

The NRLS is the largest patient rubber reporting system in the world. This study did non demonstrate many hospital characteristics to significantly influence overall reporting charge per unit. There were no clan between size of hospital, number of staff, mortality outcomes or patient satisfaction outcomes and incident reporting rate. The study did evidence that hospitals where staff reported more incidents had reduced litigation claims and when clinician staffing is increased fewer incidents reporting patient harm are reported, whilst most misses remain the aforementioned. Sure specialties report more near misses than others, and doctors report more than impairment incidents than near misses. Staff survey results showed that open environments and reduced fear of castigating response increases incident reporting. Nosotros suggest that reporting rates should not be used to assess hospital prophylactic. Different healthcare professionals focus on different types of safety incidents and focusing on these areas whilst creating a responsive, confidential learning surroundings will increase staff engagement with fault disclosure.

Citation: Howell A-Chiliad, Burns EM, Bouras G, Donaldson LJ, Athanasiou T, Darzi A (2015) Can Patient Rubber Incident Reports Exist Used to Compare Infirmary Safety? Results from a Quantitative Assay of the English National Reporting and Learning Organisation Data. PLoS ONE 10(12): e0144107. https://doi.org/10.1371/periodical.pone.0144107

Editor: Robert 50. Schmidt, University of Utah Health Sciences Centre and ARUP Laboratories, UNITED STATES

Received: Jan 24, 2015; Accepted: Nov xv, 2015; Published: December ix, 2015

Copyright: © 2015 Howell et al. This is an open access article distributed nether the terms of the Artistic Commons Attribution License, which permits unrestricted apply, distribution, and reproduction in any medium, provided the original author and source are credited

Data Availability: The authors confirm that all data underlying the findings are fully available without restriction. NRLS data can exist obtained by writing to NHS England at commissioningboard@nhs.net or england.contactus@nhs.cyberspace. All other data sources are within the paper and its supporting information files.

Funding: All authors (AMH, EB, GB, LJD, TA, Advertisement) have been commissioned past and receive funding from NHS England to implement an independent enquiry and development plan for the NRLS. NHS England had no function in study design, data collection and analysis, conclusion to publish or grooming of the manuscript. EB is supported by a Cancer Inquiry-United kingdom Clinical Lectureship (C42671/A13720). Cancer Enquiry UK had no role in report pattern, data drove and analysis, decision to publish or preparation of the manuscript.

Competing interests: The authors have alleged that no competing interests exist.

Introduction

Voluntary reporting of agin events to external agencies was initiated in the industrial and transport sectors. In these sectors, good levels of operational safety are accomplished within loftier-risk environments. [1] A database of patient safety incident reports (the National Reporting and Learning Organization; NRLS) was created inside the National Wellness Service (NHS) in England in 2003. It is now the largest repository of such incidents in the world. Similar systems to capture adverse events have now been established in many other countries.[2] The NRLS was originally designed to enable analysis of oftentimes occurring and serious events. From these reports, the NRLS developed and issued national patient rubber warnings and disseminated rubber solutions to preclude such events recurring. Regulators currently scrutinize the rates of reported rubber incidents to appraise the relative prophylactic of hospitals.[3]

Loftier profile service failures within the NHS in the United kingdom of great britain and northern ireland (Uk) have raised public concern about preventable harm in healthcare and increased the demand for transparency and accountability. It is a reasonable expectation that the big volume of information nerveless through incident reporting should allow valid judgments almost the risks to patients in one hospital compared to another. Indeed, a recent major research into the safety failings in ane English hospital expressed some incredulity that this was not already a routine component of monitoring of NHS functioning.[3]

The main regulator of NHS hospitals, the Care Quality Committee, already assesses the rates of incident reporting for individual hospitals. The reporting rate reflects not only the true number of safety incidents within an organization but besides the reporting behavior and culture within an institution. It is not clear whether examining NHS trust crude reporting rates distinguishes unsafe care or whether information technology merely reflects variation in reporting behavior. Hutchinson and colleagues examined NRLS data 2 years after incident reporting commenced in 2005 and, at that time, constitute no correlation betwixt high reporting rates and poor hospital outcome. They concluded that the lack of such an clan was nearly certainly due to low reporting rates. [4] Since this study was published reporting rates have increased to over one million patient safety incidents a year, with meaning variation between hospitals persisting.[5]

Nosotros set out the hypothesis that hospitals with improve infrastructure, lower standardized mortality rates, higher patient satisfaction and less litigation would be better at reporting patient safety incidents. Nosotros aimed to found what factors relate to the high reporting of no damage events and those incidents that lead to impairment or fifty-fifty death. In add-on, we aimed to appraise what organizational civilization factors represent to a high reporting rate using a national staff survey.

Methods

The study population included all reports of patient prophylactic incidents from NHS acute hospital trusts during the catamenia one^st January 2003 to 31^st May 2013 obtained from the NRLS database. Although all NHS organizations are required to written report incidents, those without inpatient provision, (east.g. Primary care and mental health services) were excluded from the present study. In improver, specialist hospitals such as neurosurgical or paediatric centers were excluded. These exclusions aimed to reduce the potential for bias and to ensure homogeneity of the analyzed hospital trusts. Primary intendance centers rarely report incidents and take dissimilar quality assessments. Specialist hospitals have different structural and procedure frameworks and therefore are non suitable for comparison.

Information description

The NRLS was established past National Patient Rubber Agency in 2003 and has accumulated over nine million reports since it began collection in 2003. All NHS staff are encouraged to written report the patient rubber incidents that they notice. A "patient safety incident" is defined as an event during an episode of patient intendance that had the potential to or did cause injury or harm to the patient. [6] Each report requires: demographic and administrative information: incident category, degree of harm, organization lawmaking, incident location, historic period, sexual activity and ethnicity of patient and date and fourth dimension of incident. The job description of the fellow member of staff reporting is also captured. These are chiselled variables, mainly captured in driblet-down menus. There is too a free text section in which the reporter is asked to describe what happened and what action was taken equally a effect. This written report examined the categorical data.

The reporter designates an incident'southward severity equally no harm, low harm, moderate impairment, severe harm or death. Harm is defined every bit injury or complication leading to morbidity, mortality or increased length of stay. For the purposes of understanding what factors relate to reported damage versus no harm; low harm, moderate harm, severe harm and decease were grouped as "harm".

Hospital characteristics

Several infirmary characteristics were examined. (Table 1)

Incident reporting rates for infirmary trusts in the study population were obtained from the Organization Patient Safety Incident Reports. [seven] Reporting rates were calculated per 100 admissions. The denominator of number of admissions was taken from the Hospital Episode Statistics.

The frequency of reported patient condom incident rates were correlated with hospital characteristics over the same time period. Factors associated with harm and deaths were examined in more detail. Hospital factors were considered to be either structural or functioning-related.[eight] No procedure factors were used, every bit there were non any nationally nerveless metrics that included information from all hospitals.

The hospital size was determined by 2 factors: the number of beds and staffing levels using routine NHS statistical sources. [9, 10] Total available bed numbers were calculated as the average daily number of open and staffed beds overnight. [10] The staffing rate was calculated equally full time clinicians or nurses divided by available beds to let comparing between hospitals trusts.

Summary Hospital-Level Bloodshed Indicator (SHMI) and Intendance Quality Committee (CQC), institutional level, patient survey data were used as outcome measures. SHMI figures were obtained from The NHS Data Centre [seven] The indicator reports adventure adjusted all-cause mortality 30 days mail service discharge and is derived from Infirmary Episode Statistics/Office for National Statistics linked data as a risk-adapted ratio of observed deaths over expected deaths. [11, 12] Risk-adjusted expected decease rates are calculated for diagnostic groups taking into account admission method, historic period, gender and Charlson comorbidity Index.[13] During initial assay there was significant association between SHMI and rate of reported expiry (relative risk = 0.02, 95%CI: 0.00 to 0.04,p = 0.03). (Table two) Every bit it was likely to be a confounder, information technology was removed from the analysis for factors influencing death rate.

The CQC is an independent regulator of wellness and adult social care in England. Every bit part of its role information technology surveys patients' experience of their hospital stay. Hospitals are ranked based on questions relating to overall quality of intendance. Data regarding claims and payments for litigation were obtained from the NHS Litigation Authorisation. [14]

NHS staff survey

The NHS Staff Survey collects data from staff virtually working atmospheric condition in their NHS organization. The survey asks specific questions virtually adverse events and incident reporting. [fifteen]

Statistical analysis

Statistical analysis was performed with SPSS^® version xx.0 (SPSS, Chicago, Illinois Usa.) For non-parametric variables median (interquartile range) values were given and non-parametric information were correlated using Spearman's rank correlation coefficient. P<0.05 was considered meaning for all tests.

Factors potentially influencing reporting frequency were evaluated using Pareto chart analysis to highlight the areas of vulnerability for patient prophylactic. Pareto charts express categories in descending order of frequency using a bar graph whilst the cumulative total of values or occurrences for each category is represented by a line graph.

A logistic regression model was used to examine patient and staffing factors that chronicle to the level of harm as identified by the reporter. Divide linear regression models were created for modeling reporting rates and hospital factors harm versus no impairment, and for death versus no death. Harm included low harm, moderate harm, severe harm or expiry, with no damage as the reference category. Factors with a significance level of <0.ane on bivariance analysis were included in the regression.

Upstanding approval

This research was approved by the Imperial College Joint Research Compliance Office Reference number 13SM0726. All patient records and information were anonymised and de-identified by the NRLS before beingness accessed by the research team, and therefore consent for apply of data was not required

Results

Data quality analysis

A full of 148 hospital trusts reported to the NRLS over the ten-year study menses. There were fifteen key variables that had greater than 80% complete data. (Table iii) Unfortunately variables such as patient ethnicity and fellow member of staff reporting are non mandatory categories and are poorly completed. Overall reporting rates increased exponentially from 2003 to 2013. In total, 66, 931 incidents for acute hospitals were reported between 2003 and 2005 equally the penetrance of the system increased. In 2013, during the one-year period, in that location were i,093,091 reports.

Trends in reported harm and death

Over 60% of reports concerned patients over the historic period of 65 years. The patients almost probable to be included in an incident report were in the 76–85 yr age group (867,548 reports) When damage was reported over half of such incidents involved patients in medical specialties. (Figs 1 and 2)

Relationship between reported harm and patient or staff factors

Using binary multiple logistic regression analysis, the effects of patient historic period, gender, specialty, month, location, time and twenty-four hour period of report on whether a damage written report or no harm written report were assessed.

The age group 76–85 years was about likely to have incidents reported [OR 1.49 (CI 1.44–1.54) p<0.05]. Male patients were less likely to have reported harm OR 0.93 (95%CI: 0.92–0.94), p<0.001. No harm incidents were well-nigh likely to exist reported from chemist's shop [OR 3.03 (95%CI: 2.04–4.55), p<0.001].

Patients were virtually likely to have a damage study during their stay if admitted under the medical specialties [OR 1.77 (95%CI: ane.71–i.83), p<0.001]. Obstetrics and gynaecology professionals reported the about near miss reports: OR 1.61 (95%CI: ane.12–ii.27) (p = 0.009) Clinicians were slightly more likely to file a damage report than other specialties when adjusted for age, gender, month, location, time, weekend [OR 1.085 (95%CI: one.050–1.121), p<0.01)].

Relationship between reported expiry and patient and staff factors

Clinicians were significantly more likely to report deaths than other staff members [OR 3.04 (95%CI: 2.43–3.80) p<0.01]. When adjusted for all factors decease was more likely to be reported at night [OR ane.25 (95%CI: i.13–1.39), p<0.01].

Human relationship between reporting rates and hospital characteristics

Infirmary level information were examined for 2011. There were 399,751 reports included during 2011. Of these reports, 11,5031 (28%) were impairment reports and 688 (0.17%) were reported as deaths. The median number of reports beyond all hospital trusts was 5.87 [Inter-quartile Range (IQR) = 2.06] per 100 admissions and the median number of deaths reported was 0.01 (IQR = 0.01) per 100 admissions.

Structural factors

The median number of full time clinicians per bed per hospital trust was 0.77 (IQR = 0.23). In that location were no significant associations between clinicians per bed and overall rate of reporting or reported deaths (Table four). There was a significant negative association between clinicians per bed and rate of reported harm [Relative run a risk (RR) = -1.78, 95% Confidence Interval (CI): -iii.33 to-0.23, p = 0.03] (Table v).

The median number of full time nurses per bed per hospital trust was 1.82 (IQR = 0.38). There were no significant associations betwixt nurses per bed and overall rate of reporting or reported harm or deaths. (Tables 4 and 5)

Twenty-vii hospitals were classed equally pedagogy hospitals and there were no significant associations with overall rate of reporting or reported harm or deaths. (Tables four and 5)

Issue factors

There were no significant associations between SHMI and overall rate of reporting or reported harm. (Tables 3 and 4)

The overall CQC survey response rate was 53%. [xvi] CQC median overall scores were 6.40 (IQR = 0.xl). (Table three) There were no significant associations between CQC scores and overall rate of reporting or reported harm or deaths. (Tables iv and v)

The median number of NHS Litigation Authority (LA) claims per hospital trust per bed was 0.06 (IQR = 0.00). There were no significant associations betwixt claims and rate of reported harm or reported deaths. The number of claims negatively correlated with the reported harm rate (RR = ix.thirty 95%CI: 2.04 to 16.54, p = 0.01) (Table 5).

Barriers to reporting: investigating relationship between reporting rates and NHS staff survey

The median number of staff per trust responding to the NHS Staff survey questions was 399 (IQR = 93.5). NHS staff survey questions related to incident reporting showed pregnant correlations between reporting charge per unit and the following factors: infirmary trusts that encourage reporting [r = 0.26 (p = 0.001)], go on reports confidential [r = 0.17 (p = 0.04)], keep staff informed about incidents [r = 0.23 (p = 0.01)] and feedback on changes made [r = 0.20 p = 0.02)]. Hospital trusts that penalized staff for incidents had a negative correlation with reporting rate [r = -0.18 (0.03)]. (Table 6)

Discussion

The rate of patient safety incident reports in the NHS in England has increased exponentially since drove began. This reflects the emphasis placed on patient safe by successive governments and the willingness of front end-line staff to provide information that is ultimately intended to reduce the risks of care.[17–xix]

Reporting trends

Our analysis reveals that patients most vulnerable to reported damage are elderly medical inpatients. This merely corresponds to the inpatient population as virtually two thirds of United kingdom hospital admissions are patients aged over 65 years, and account for approximately 70% of bed days.[20] In addition to factors such as increased frailty over 85 year olds business relationship for 25% of bed days and accept, on boilerplate, a significantly longer hospital stay than younger patients.[20]

We observed that clinicians are significantly more than probable to report a death than other members of staff, although there were lower rates of reports filed by clinicians overall, in keeping with other studies.[11, 21] Such variation may reverberate the perceived level of responsibility for treatment different levels of harm. Using reports of death to trigger safety initiatives may motivate clinicians ameliorate than near miss reports.[21]

Obstetrics and gynaecology patients were more likely to have a no harm event reported than whatsoever other specialty. This specialty has an established history of reporting and a strong safety civilisation supported through established national audits into all maternal and neonatal morbidity and bloodshed. This may account for the dedication to reporting all patient condom incidents.

The hospital setting in which patients were well-nigh likely to have a near miss reported was in pharmacies. This first-class level of reporting may be explained through the process of medicine reconciliation. This is where medication errors are scrutinized closely and is a National Constitute for Health and Clinical Excellence (NICE) guideline and shown to be effective in preventing harm.[22] The alternating explanation is that more well-nigh misses occur in chemist's shop.

Total reporting rate and infirmary characteristics

Hospitals with meliorate reporting records practise non accept particular differentiating hospital characteristics. (Tables ii and iv) Staffing levels and teaching hospital status did not impact significantly on reporting rates. Unlike other studies nosotros were unable to find an association betwixt nursing staff levels and reported events. Our written report took into business relationship other organizational factors in the analysis.[23, 24]

The SHMI for hospital trusts had no demonstrable human relationship with overall reporting rates. It was hypothesized that a low SHMI would correlate with a high overall reporting charge per unit, suggesting that a hospital with a lower unexpected mortality rate would have a stronger safe culture, reporting and learning from incidents more than frequently and therefore tackling failures that lead to patient impairment. This was not the case. (Table 4) There were no associations between overall reporting rates and patient satisfaction and care every bit measured through the CQC survey or as stated hospital trust SHMI. Litigation payments were not correlated with overall reporting rates, but there was a significant negative association with claims and reporting rates.

It is important to note that at that place were no meaning relationships betwixt overall reporting rates and about hospital construction and issue factors. This is in accordance with before studies and persists despite of increased reporting rates.[25] When Sari and colleagues, in 2007, examined adverse events recorded in instance notes they found that the NRLS identifies only 5% of errors that cause harm to patients.[26] The NRLS cannot in its current course quantify the safety of a hospital. It is important that the data are not used to depict conclusions that are clouded by non-responder bias.

This problem is not unique to the NHS organisation. A report in 2012 from the inspector General of the Department of Health and Human Services in the U.s.a. institute that just fourteen% of adverse events experienced by Medicare patients are captured.[27] The report noted that incident reporting systems were relied on to identify safe bug, although administrators were enlightened the data were incomplete. Reasons for low reporting included staff non being aware of what events constituted harm.[27] This study recommended that the Agency for Healthcare Research and Quality (AHRQ) create a list of reportable events in collaboration with the Centers for Medicare and Medicaid Services.

Reported impairment rate and hospital characteristics

There were some associations found when incidents that caused patient harm were separated out and correlated with hospital characteristics.

Clinician-bed ratio corresponded to a meaning reduction in the rate of harm reported, (although not having a relationship with overall reporting rates that included near misses). (Table 5) Information technology may be that intendance received by patients is safer when clinician staffing is increased. Similarly, a study by Ghaferi et al as well found that reduced rates of failure to rescue (death after a treatable surgical complication) in England were associated with a college number of doctors per bed.[28]

Reporting rates and litigation claims

There was a positive clan between litigation claims and reported harm, when analysed separately from overall reporting rates. (Table 5) This is an interesting finding that contrasts to the negative association betwixt litigation claims and overall reporting rates. One interpretation may be that hospitals reporting more have a stronger safety culture and therefore are less probable to take patients claiming for malpractice.

With respect to the positive clan between claims and harm specific reports we propose that generally staff may study specific incidents of harm when they are aware of the potential for patient claims and this may exist to mitigate the litigation or provide real time documentation and accountability. This may exist an area for farther written report if hospitals can use specific harm reporting data to identify areas of potential litigation risk.

Insights from the NHS Staff Survey

Previous studies found relationships betwixt high reporting rates and safety culture as assessed past the NHS Staff Survey. [25] Potential reasons for health care workers underreporting include concerns over reputation or peer disapproval, lack of meaningful feedback from the organization or uncertainty regarding who was responsible for reporting.[eleven, 12, 29] The NHS Staff survey questions reflected NRLS reporting rates considering hospital trusts where people stated that they reported events, the reporting rate was higher. Hospital trusts that encouraged reporting, had imposed confidentiality on reports, fed back to staff about incidents and promoted change had significantly higher reports. Hospital trusts that were deemed to take punished reporters had significantly lower reporting rates.

Suggestions to improve learning from reporting

There is potential for redeveloping the data drove process to facilitate specialty based reporting, a method that has been successfully pioneered by the Australian Incident Monitoring System. [xxx] Accurate measurement of incidents requires standardized definitions of types of adverse event or complications for the given specialty and a minimum dataset is crucial for information homogeneity. [31] Our suggestions are two-fold. The offset is to more tightly ascertain a few specific incidents to be reported nationally then that staff tin focus their reporting efforts. This has been adopted successfully in other systems, such as the Hong Kong system where specific patient safety incidents including never events are focused on and mandated. Secondly nosotros suspect the true value of the NRLS reports lie in the patterns and trends picked up in the detail of the "gratis-text" section of the incidents. It may be more useful to focus local reporting systems on trying to capture why incidents occur rather than how often they occur. The electric current database should exist fully exploited to sympathize the system failures that lead to patient harm. Methods for rapid free text assay must exist developed to enable real-fourth dimension alarm systems for at risk specialties or institutions. [32]

Limitations

This study was limited by the paucity of commonly used national measures of hospital quality available to compare with reporting rates. These measures are often proxy metrics for quality and safety and all of them are decumbent to criticism.

Staffing and bed numbers are basic methods for understanding infirmary structure and do non fully appraise the complexities of hospitals as organizations. Despite this staffing numbers per bed take been reported to relate to patient prophylactic and outcome, increased nurse staffing has been associated with lower adverse events and reduced hospital related mortality. This may justify our apply of these measures for comparison and assessment.[2, 33–38] Future studies should include other structural factors such as the availability of advisable Information technology equipment to facilitate reporting to fully sympathize discrepancies in reporting rates betwixt hospitals.

The upshot measures we used to compare with incident rates are well known methods for assessing and benchmarking hospital performance.

SHMI is a commonly used measure of hospital functioning and measures deaths adjusted for comorbidities. There has been criticism in the literature of SHMI every bit an result mensurate. The indicator relies on routinely collected data that tin can be inaccurate. A recent study showed that there were only weak associations between the proportion of avoidable deaths and the SHMI and that there were few significant differences between hospitals when avoidability of expiry was assessed. [39] However excess mortality as an endpoint is a useful broad indicator of quality and the SHMI has been recognized as transparent and reproducible. Information technology is currently used as an acceptable method to flag hospitals that may be poorly performing.[40] Therefore we suggest that it was an appropriate standard to correlate with reporting rates. Future studies should seek to compare hospital reported decease figures with infirmary avoidable mortality demonstrated using retrospective case note review.

CQC patient survey results are issue factors commonly used to characterize institutions.[35, 41, 42] With respect to using CQC patient survey results there is potential for bias in relying on the patient'southward perception of care. Patients may over-estimate condom inside an institution as they are not necessarily aware of safety issues. [43] Nonetheless we wanted CQC survey results to exist included as information technology is some other dimension in the established definition of hospital quality.[44] The function of patients in monitoring their ain care is becoming increasingly of import.

The factors used in this study attempted to encapsulate measurable features of hospital care. This study chose reproducible, routinely nerveless information representing quantitative factors relating to hospital care, but the authors acknowledge that some organizations may have process factors, improved teamwork, communications and condom strategies, which have non been assessed in this study and that may well affect on reporting rates of patient safety incidents.[45, 46] This does limit the full assessment of whether reporting rates relate to hospital quality of care.

Using the staff survey has limitations with respect to assessing the quality of a hospital trust, every bit was shown by Pinder et al where there were weak negative correlations of staff survey results with mortality statistics.[47] However the survey does correlate with patient experience and takes views from a wide spectrum of thousands of staff members. We used the staff survey to understand what views regarding reporting influenced reporting rates and these were consistent in suggesting that staff perception is a potent moderator of reporting rate.

What this study adds

Information technology has been suggested that voluntary reporting may not be the all-time style to gather accurate information regarding how safe a infirmary is.[48, 49] Particularly as public attending has been drawn towards patient prophylactic and incident reporting, the variation in rates must be explained adequately.[50] Our findings concord that reported rates of events practise not correlate strongly with other measures of hospital structure or performance. Nosotros advise that to understand how condom a hospital is other information sources must be used. Using reporting rates, as an indicator of the relative safe or quality of a hospital trust is likely to be inaccurate. [51] When reports are separated into incidents that crusade harm versus no harm there does seem to exist a human relationship between harm levels and clinician staffing. There is also correlation between harm and litigation claims. Looking at reported impairment rates may be a useful area for further study. This study also shows that unlike specialties and staff focus on reporting different levels of patient harm. There was correlation betwixt high reporting rates and confidential, only open reporting environments. Tailoring reporting to individual staff concerns may create ameliorate appointment from frontline staff.

Conclusions

The NRLS is the largest patient safety reporting system in the world. This report did not observe many hospital characteristics that significantly influenced overall incident reporting rates. There were no relationships between size of hospital, numbers of staff, bloodshed outcomes or patient satisfaction outcomes and reporting rates. The study did bear witness that hospitals where staff reported more incidents had reduced litigation claims and when clinician staffing is increased fewer incidents reporting patient impairment are reported, whilst near misses remain the aforementioned. Certain specialties written report more than near misses than others, and doctors study more than harm incidents than nearly misses. Staff survey results showed that open environments and reduced fearfulness of punitive response increases reporting. Nosotros suggest that reporting rates should non exist used to assess infirmary rubber. Different healthcare professionals focus on dissimilar types of safe incident and focusing on these areas whilst creating a responsive, confidential learning environs volition increase staff engagement with error disclosure.

Writer Contributions

Conceived and designed the experiments: AD TA LJD. Performed the experiments: AMH EB GB. Analyzed the information: AMH EB GB TA. Contributed reagents/materials/analysis tools: Advertising LJD. Wrote the newspaper: AMH GB EB TA LJD AD. Drafted, revised and approved the article prior to submission: AMH EB GB LJD TA AD. Guarantor: AD.

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