Adverse Event Reporting Systems May Need Improvement -- Duh

[Guest guest]

not talking about the vaccine system but the same issue

Sheri

http://www.medscape.com/viewarticle/585301?src=rss

Adverse Event Reporting Systems May Need Improvement

Laurie Barclay, MD

December 12, 2008 ­ A national survey evaluating

the present status of US hospital-based adverse

event reporting systems suggests needed

improvements in reporting processes, according to

a report in the December issue of Quality and Safety in Health Care.

" Little is known about hospitals' adverse-event

reporting systems, or how they use reported data

to improve practices, " write D. O. Farley, from

the RAND Corporation in Pittsburgh, Pennsylvania,

and colleagues. " This information is needed to

assess effects of national patient-safety

initiatives, including implementation of the

Patient Safety and Quality Improvement Act of

2005 (PSQIA). This survey generated baseline

information on the characteristics of hospital

adverse-event-reporting systems and processes,

for use in assessing progress in improvements to reporting. "

From September 2005 through January 2006, risk

managers for a stratified random sample of 2050

nonfederal US hospitals completed the Adverse

Event Reporting Survey, developed by Westat,

using a mixed-mode (mail/telephone) survey.

Response rate was 81%, yielding a sample of 1652 completed surveys.

Although specific characteristics varied,

virtually all hospitals surveyed reported having

centralized adverse event reporting systems. Four

performance indexes were scored, revealing that

only 32% of hospitals had established

environments that supported reporting, only 13%

had adverse event reporting by a wide range of

staff, and only 20% to 21% widely distributed and

reviewed summary reports on identified adverse events.

Limitations of this survey included that

responses were self-reported by risk managers,

which could result in optimistic evaluations of

hospital performance in adverse event reporting.

" Survey findings document the current status of

hospital adverse-event-reporting systems and

point to needed improvements in reporting

processes, " the study authors write. " PSQIA

liability protections for hospitals reporting

data to patient-safety organisations should also

help stimulate improvements in hospitals'

internal reporting processes. Other mechanisms

that encourage hospitals to strengthen their

reporting systems, for example, strong

patient-safety programmes, also would be useful. "

The Agency for Healthcare Research and Quality,

US Department of Health and Human Services,

supported this study. The authors have disclosed

no relevant financial relationships.

Qual Saf Health Care. 2008;17:416–423.