Most Faculty and Residents Inclined to Report Errors, But Few Actually Have Done So -- by Pat F. Bass III M.D., M.S., M.P.H.

Pat F. Bass III M.D., M.S., M.P.H. is Assistant Professor of Medicine/Pediatrics at Louisiana State University Health Sciences Center - Shreveport.

 

While faculty physicians and residents report that they value error reporting, there may be a discrepancy between self-reported attitudes and actual reporting behaviors, according to a recent report in the Archives of Internal Medicine.  Lauris C. Kaldjian, M.D., PhD., of the Division of General Internal Medicine at the University of Iowa Roy J.and Lucille A. Carver College of Medicine in Iowa City, Iowa, and colleagues surveyed residents and faculty from three medical centers in the Midwest, Mid-Atlantic, and Northeast regions of the U.S..  The survey examined whether faculty and residents had reported actual errors, their likelihood of reporting hypothetical errors, and their attitudes toward reporting errors.
 
Overall, the response rate to the survey was 74 % and most respondents (84.3%) agreed that error reporting improved quality of care.  Most respondents stated they would report a hypothetical error leading to minor harm to a patient (extended treatment or pain), and major harm to a patient (disability or death) (73% and 92%, respectively).  However, only 17.8% had actually disclosed minor and errors and just 3.8% had disclosed major errors to patients.  About the same proportion of respondents admitted not reporting actual minor (16.9%) and major errors (3.8%).  Additionally, only slightly more than half of respondents knew how to report errors and nearly 4 in 10 were unsure of what kind of errors to report. A multivariate analysis of hypothetical scenarios revealed that believing that error reporting improves care, knowing the error reporting process, thinking that forgiveness is important, and being a faculty member were associated with willingness to report errors.  

"Taken together, these results suggest there may be a gap between attitude and practice among physicians regarding the reporting of medical errors," the authors comment.  While there is a knowledge deficit among physicians regarding which errors to report and how to do it, education alone may not improve error reporting.  Physicians may under-report errors that did not cause harm (often called  "near misses”).  Other barriers to reporting may include questions about who is to blame and legal liability.  The authors conclude that "institutions should consider ways to promote patient-centered ethical values that may motivate physicians to report errors in the midst of countervailing pressures, especially in teaching hospitals where role models play a vital part in the formation of trainees’ attitudes and practices. Such values are rightly seen as part of medical professionalism and reflect a commitment not merely to good systems but to the good of our future patients."

 

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