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Electronic letters published:
![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
The Submission of Confidential Error Reports
Importance of clarifying purpose of error reports
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Deborah G Graham, Leawood, KS Senior Research Associate, American Academy of Family Physicians, National Research Network
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This paper by Fernald et al provides a thorough description of errors reported in primary care settings by means of both an anonymous reporting mechanism and a confidential reporting mechanism. Several important results are reported: (1) All reporter groups (clinicians, nursing staff, and nonclinical staff) were more likely to submit confidential reports than anonymous reports. (2) No particular type of event was reported more or less often by confidential reporting. (3) Confidential reports contained more complete information than anonymous reports. (4) The levels of harm reported did not differ between confidential and anonymous reports. These results point to a win-win situation for the use of confidential reporting over anonymous reporting in a safe and secure reporting system. These results plus the recent passage of the Patient Safety and Quality Improvement Act in the U.S. Senate and House, S.720 and H.R.663, respectively, should promote a more widespread use of confidential reporting systems, and consequently more complete data, in patient safety research and the design of interventions to improve patient safety and the quality of care. Competing interests: None declared |
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Nancy C Elder, Cincinnati, USA Associate Professor, Family Medicine, University of Cincinnati
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Fernald and colleagues’ report on 608 ambulatory care error reports from the ASIPS collaborative is an important advancement in this rapidly developing field of primary care error reporting. By choosing to include (and compare) both a confidential and an anonymous system, they provide rich information to policy makers considering various error reporting systems. As the authors point out, which system one chooses depends in large part on the desired goal. For making decisions based on harm, risk and broad categorizations of error, anonymous reports may suffice. For ongoing feedback and education to practices and practitioners, the expanded data from confidential reports offers greater potential for intervention and improvement. Policy makers, researchers, insurers and practitioners would do well to assess why they want to know about errors before they invest the time, effort and expense in reporting systems. Often forgotten by policy makers in their hurry to institute “error reporting systems,” the difficulty, complexity and time-intensive nature of coding error reports is appropriately summarized in this report, although probably still at a confusing level for those who haven’t read other reports from the ASIPS collaborative, attended one of their presentations at national meetings such as NAPCRG, or are actively involved in this area of research. Axes, domains and coding categories speak to the difficulty of collating, collapsing and summarizing error reports into a fashion that is useful and understandable to both policy makers and practitioners. Developing systems of coding and summarizing reports to produce results that are acceptable for the desired purpose yet are quickly, efficiently and cheaply performed is still an elusive goal. Practices in the ASIPS collaborative were paid $50.00 for each completed confidential report. In our own AHRQ funded work through the AAFP National Research Network, we reimbursed practices a set amount for participating in ongoing anonymous error reporting. Recent national legislation has called for voluntary error reporting. Making error reports requires a time (and therefore a financial) commitment from practices. Future error reporting systems will need to make it worthwhile to busy practitioners to make error reports. Researchers have depended on financial remuneration, but ultimately the value of error reporting will need to stand on its own. This will require that these reports be tied to quality, efficiency and safety feedback to practices, by overcoming the costly and time intensive barriers of data extraction, coding, summarizing and reporting, not to mention the perceived and real barriers of legal and malpractice risk. Competing interests: None declared |
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