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Weissman JS, Annas CL, Epstein AM, et al. Error Reporting and Disclosure Systems: Views From Hospital Leaders. JAMA. 2005;293(11):1359–1366. doi:10.1001/jama.293.11.1359
Author Affiliations: Institute for Health Policy,
Massachusetts General Hospital, Boston (Dr Weissman and Ms Feibelmann); Department
of Health Care Policy, Harvard Medical School, Boston, Mass (Dr Weissman);
Department of Health Policy and Management, Harvard School of Public Health,
Boston, Mass (Drs Epstein and Schneider); Division of General Medicine and
Primary Care, Department of Medicine, Brigham and Women’s Hospital,
Boston, Mass (Drs Epstein and Schneider); Massachusetts Department of Public
Health, Boston (Mss Annas and Ridley); Center for Survey Research, University
of Massachusetts, Boston (Dr Clarridge); Massachusetts Hospital Association,
Burlington (Ms Kirle); and Center for Statistical Sciences and Applied Mathematics,
Brown University, Providence, RI (Dr Gatsonis).
Context The Institute of Medicine has recommended establishing mandatory error
reporting systems for hospitals and other health settings.
Objective To examine the opinions and experiences of hospital leaders with state
Design and Setting Survey of chief executive and chief operating officers (CEOs/COOs) from
randomly selected hospitals in 2 states with mandatory reporting and public
disclosure, 2 states with mandatory reporting without public disclosure, and
2 states without mandatory systems in 2002-2003.
Main Outcome Measures Perceptions of the effects of mandatory systems on error reporting,
likelihood of lawsuits, and overall patient safety; attitudes regarding release
of incident reports to the public; and likelihood of reporting incidents to
the state or to the affected patient based on hypothetical clinical vignettes
that varied the type and severity of patient injury.
Results Responses were received from 203 of 320 hospitals (response rate = 63%).
Most CEOs/COOs thought that a mandatory, nonconfidential system would discourage
reporting of patient safety incidents to their hospital’s own internal
reporting system (69%) and encourage lawsuits (79%) while having no effect
or a negative effect on patient safety (73%). More than 80% felt that the
names of both the hospital and the involved professionals should be kept confidential,
although respondents from states with mandatory public disclosure systems
were more willing than respondents from the other states to release the hospital
name (22% vs 4%-6%, P = .005). Based on
the vignettes, more than 90% of hospital leaders said their hospital would
report incidents involving serious injury to the state, but far fewer would
report moderate or minor injuries, even when the incident was of sufficient
consequence that they would tell the affected patient or family.
Conclusions Most hospital leaders expressed substantial concerns about the impact
of mandatory, nonconfidential reporting systems on hospital internal reporting,
lawsuits, and overall patient safety. While hospital leaders generally favor
disclosure of patient safety incidents to involved patients, fewer would disclose
incidents involving moderate or minor injury to state reporting systems.
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