Error reporting in the emergency department: do we do what we say we do?

BACKGROUND: The Joint Commission accreditation manual contains standards in improving organization performance related to report and review of patient care issues causing unexpected harm. In spite of regulations mandating reporting, it remains inconsistent, varying by provider type and hospital. Our purpose was to determine current attitudes, knowledge, and practice of error reporting among emergency department (ED) providers.
METHODS: We administered a survey assessing ED staff practice regarding error reporting. Questions involved reporting of errors in which the practitioner was directly involved, errors the practitioner observed, and general awareness of reporting mandates. We also questioned individuals regarding fear of repercussions for reporting.
RESULTS: Fifty-two surveys were returned. For most errors, providers were more likely to tell their supervisor about the issue than to tell the patient. Seventeen percent of respondents did not think that referring errors for review was their job. Only 31% of respondents were aware of standardized institution-wide pathways to report errors. Any respondent who was aware of the institution-wide pathway also felt responsibility for error reporting. Thirty-three percent of the respondents were concerned about negative repercussions from reporting errors. In querying the hospital reporting system, 263 cases were referred for quality issues over the previous year, 51% of them were referred by nurses, 27% by medical technicians (MTs), 2% by mid-level providers (MLPs), 1% by physicians, and 19% by other personnel.
CONCLUSION: Although most of the ED staff are responsible for patient safety, most are not aware of systems available to assist in reporting, and even many do not utilize those systems.