Original Research

An Analysis of the Involvement and Attitudes of Resident Physicians in Reporting Errors in Patient Care

Journal of Clinical Outcomes Management. 2021 March;28(2):62-69 | 10.12788/jcom.0040

References

1. Zallman L, Ma J, Xiao L, Lasser KE. Quality of US primary care delivered by resident and staff physicians. J Gen Intern Med. 2010;25(11):1193-1197.

2. Bagain JP. The future of graduate medical education: a systems-based approach to ensure patient safety. Acad Med. 2015;90(9):1199-1202.

3. Kachalia A, Kaufman SR, Boothman R, et al. Liability claims and costs before and after implementation of a medical disclosure program. Ann Intern Med. 2010;153(4):213-221.

4. Kaldjian LC, Jones EW, Wu BJ, et al. Reporting medical errors to improve patient safety: a survey of physicians in teaching hospitals. Arch Intern Med. 2008;168(1):40-46.

5. Rowin EJ, Lucier D, Pauker SG, et al. Does error and adverse event reporting by physicians and nurses differ? Jt Comm J Qual Patient Saf. 2008;34(9):537-545.

6. Turner DA, Bae J, Cheely G, et al. Improving resident and fellow engagement in patient safety through a graduate medical education incentive program. J Grad Med Educ. 2018;10(6):671-675.

7. Macht R, Balen A, McAneny D, Hess D. A multifaceted intervention to increase surgery resident engagement in reporting adverse events. J Surg Educ. 2015;72(6):e117-e122.

8. Scott DR, Weimer M, English C, et al. A novel approach to increase residents’ involvement in reporting adverse events. Acad Med. 2011;86(6):742-746.

9. Stewart DA, Junn J, Adams MA, et al. House staff participation in patient safety reporting: identification of predominant barriers and implementation of a pilot program. South Med J. 2016;109(7):395-400.

10. Vidyarthi AR, Green AL, Rosenbluth G, Baron RB. Engaging residents and fellows to improve institution-wide quality: the first six years of a novel financial incentive program. Acad Med. 2014;89(3):460-468.

11. Fok MC, Wong RY. Impact of a competency based curriculum on quality improvement among internal medicine residents. BMC Med Educ. 2014;14:252.

12. Wijesekera TP, Sanders L, Windish DM. Education and reporting of diagnostic errors among physicians in internal medicine training programs. JAMA Intern Med. 2018;178(11):1548-1549.

13. Levinson DR. Hospital incident reporting systems do not capture most patient harm. Washington, D.C.: U.S. Department of Health and Human Services Office of the Inspector General. January 2012. Report No. OEI-06-09-00091.

14. Evans JR, Mathur A. The value of online surveys. Internet Research. 2005;15(2):192-219.

15. Marcano Belisario JS, Jamsek J, Huckvale K, et al. Comparison of self‐administered survey questionnaire responses collected using mobile apps versus other methods. Cochrane Database of Syst Rev. 2015;7:MR000042.

16. Manfreda KL, Batagelj Z, Vehovar V. Design of web survey questionnaires: three basic experiments. J Comput Mediat Commun. 2002;7(3):JCMC731.

17. Wright ND, Groisman‐Perelstein AE, Wylie‐Rosett J, et al. A lifestyle assessment and intervention tool for pediatric weight management: the HABITS questionnaire. J Hum Nutr Diet. 2011;24(1):96-100.

Besides providing high-quality care, it is important that residents play an active role in the reporting of errors that occur regarding patient care as well as in identifying events that may compromise patient safety and quality.² In fact, increased reporting of patient errors has been shown to decrease liability-related costs for hospitals.³ Unfortunately, physicians, and residents in particular, have historically been poor reporters of errors in patient care.⁴ This is especially true when comparing physicians to other health professionals, such as nurses, in error reporting.⁵

Several studies have examined the involvement of residents in reporting errors in patient care. One recent study showed that a graduate medical education financial incentive program significantly increased the number of patient safety events reported by residents and fellows.⁶ This study, along with several others, supports the concept of using incentives to help improve the reporting of errors in patient care for physicians in training.^7-10 Another study used Quality Improvement Knowledge Assessment Tool (QIKAT) scores to assess quality improvement (QI) knowledge. The study demonstrated that self-assessment scores of QI skills using QIKAT scores improved following a targeted intervention.¹¹Because further information on the involvement and attitudes of residents in reporting errors in patient care is needed, University Hospitals of Cleveland (UH) designed and implemented a QI study during the 2018-2019 academic year. This prospective study used anonymous surveys to objectively examine the involvement and attitudes of residents in reporting errors in patient care.

Methods

The UH health system uses Patient Advocacy and Shared Stories (PASS) reports as incident reports to not only disclose errors in patient care but also to identify any events that may compromise patient safety and quality. Based on preliminary review, nurses, ancillary staff, and administrators file the majority of PASS reports.

The study group consisted of residents at University Hospitals–Regional Hospitals (UH-RH), which is comprised of 2 hospitals: University Hospitals–Richmond Medical Center (UH-RMC) and University Hospitals –Bedford Medical Center (UH-BMC). UH-RMC and UH-BMC are 2 medium-sized university-affiliated community hospitals located in the Cleveland metropolitan area in Northeast Ohio. Both serve as clinical training sites for Case Western Reserve University School of Medicine and Lake Erie College of Osteopathic Medicine, the latter of which helped fund this study. The study was submitted to the Institutional Review Board (IRB) of University Hospitals of Cleveland and granted “not human subjects research” status as a QI study.

Surveys

UH-RH offers residency programs in dermatology, emergency medicine, family medicine, internal medicine, orthopedic surgery, and physical medicine and rehabilitation, along with a 1-year transitional/preliminary year. A total of 80 residents enrolled at UH-RH during the 2018-2019 academic year. All 80 residents at UH-RH received an email in December 2018 asking them to complete an anonymous survey regarding the PASS report system. The survey was administered using the REDCap software system and consisted of 15 multiple-choice questions. As an incentive for completing the survey, residents were offered a $10 Amazon gift card. The gift cards were funded through a research grant from Lake Erie College of Osteopathic Medicine. Residents were given 1 week to complete the survey. At the end of the week, 54 of 80 residents completed the first survey.