Renewed interest surged again in 2000 when the Institute of Medicine published the report, To Err Is Human: Building a Safer Health System.[ii] This resulted in a task force being assembled to recommend improved patient safety measures, and eventually led to a mandatory reporting system being put in place across the US.[iii] Since then, many healthcare studies have suggested that mandatory AND voluntary systems work together to improve patient safety in the healthcare system.
Other notable movements in event reporting and patient safety were the 100,000 Lives Campaign and a study in Minnesota which asked respondents to rate the priority level of patient safety before and after the passage of a state-wide event reporting law.[iv]
The Minnesota study showed that physicians need to be “engaged in and supportive of newly-implemented policies and practices” to create a “culture in which all team members feel comfortable speaking up about safety risks.”[v]
Both mandatory and voluntary reporting systems currently operate through the United States with varying level of success. Although organizations throughout the United States have seen improvements in patient safety based on event reporting practices, many are still trying to implement better event reporting processes and best practices. So where do we see event reporting going?
Updating event reporting systems and policies can lead to many benefits. Here are some ideal characteristics we will see as event reporting continues to improve:
If you have any questions about event reporting, symplr can help! We offer event reporting software as a service to healthcare organizations who need to reduce risk and improve patient safety. Have a question or want to have a walk through our services? Click here to learn more about event reporting today!
[i] Brennan TA, Leape LL, Laird NM. et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. NEJM. 1991 Feb 7;324(6):370–6.
[ii] Kohn LT, Corrigan JM, Donaldson, MS, editors. To err is human: building a safer health system. A report of the Committee on Quality of Healthcare in America, Institute of Medicine. Washington, DC: National Academy Press; 2000.
[iii] Flink E, Chevalier CL, Ruperto A. et al. Lessons learned from the evolution of mandatory adverse event reporting systems. Advances in Patient Safety: From Research to Implementation. 3;2005. http://www.ncbi.nlm.nih.gov/books/NBK20547/
[iv] Adverse healthcare events reporting system: What have we learned? 5-year review. Minnesota Department of Health. 2009 Jan. http://www.health.state.mn.us/patientsafety/publications/09aheeval.pdf