Physicians Believe in Reporting Errors but Rarely Do

By Charles Bankhead
IOWA CITY, Iowa, Jan. 15 -- Most physicians support the concept of reporting medical errors, but few have actually reported one, investigators here have found.Three-fourths of physicians surveyed said they would report an error that caused minor harm to a patient and more than 90% would report an error causing major harm, Lauris C. Kaldjian, M.D., Ph.D., of the University of Iowa, and colleagues reported Jan. 14 in the Archives of Internal Medicine.However, only 17.8% of the physician respondents had actually reported a minor error, and only 3.8% had ever reported a major error.
In addition to the low rates of actual reporting of medical errors, the survey results showed that 16.9% of respondents conceded they had kept mum on a minor error they had committed or witnessed, and 3.8% had done the same on a major error they had committed or witnessed.
The survey responses also reflected widespread lack of understanding about the reporting of medical errors. More than half of the respondents (54.8%) did not know how to report errors, and only 39.5% knew what types of errors should be reported.
"The results of this study suggest that physicians' attitudes about the value of error reporting may not be matched by actual behavior," the authors concluded. "If correct, the potential causes of this discrepancy ought to be addressed."
Considering all acknowledged errors, both reported and unreported, leads to the conclusion that only 36% of the respondents acknowledged ever making a minor or major error, Dr. Kaldjian said in an interview. "We know that's probably not the whole story. There's a certain amount of underreporting."
Health care institutions need to establish an environment that emphasizes the educational aspects of error reporting and ensures confidentiality, the authors added.
The authors surveyed faculty members and residents at three medical centers in the midwest, mid-Atlantic region, and northeast. At the time of the survey, two of the three states included in the study had enacted mandatory reporting legislation.
The survey included a hypothetical clinical case in which a medical error occurred. The case had three possible patient outcomes: no harm, minor harm, and major harm. Survey respondents indicated how likely they would be to report the error for each of the three outcomes.
The investigators received 338 completed surveys from FPs, internists, and pediatricians, representing a 74% response rate.
The authors said that 84.3% of respondents agreed that error reporting improves the quality of patient care. Additionally, 73% said they would likely report a minor error, and 92% said they would report a major error.
Multivariate analyses of responses to the clinical case showed that willingness to report medical errors was associated with the belief that reporting improves quality of care, knowing how to report errors, believing in forgiveness, and being a faculty (versus resident) physician.
Without institutional efforts that encourage and facilitate reporting of medical errors, "the effect of federally protected patient safety reporting systems is likely to be reduced and the reporting bias inherent in these systems will be unlikely to diminish," the authors concluded.
The authors noted several limitations of the study, including the possibility of social desirability bias, the fact that answers to hypothetical scenarios may not predict actual behavior, and data were collected in 2004 and 2005 and may not reflect more current attitudes or practices.
The study was supported by the Robert Wood Johnson Foundation.
The authors reported no potential conflicts of interest.
Primary source: Archives of Internal MedicineSource reference:Kaldjian LC, et al "Reporting medical errors to improve patient safety: a survey of physicians in teaching hospitals" Arch Intern Med 2008; 168: 40-46.