Hirose Masahiro, Regenbogen Scott E, Lipsitz Stuart, Imanaka Yuichi, Ishizaki Tatsuro, Sekimoto Miho, Oh Eun-Hwan, Gawande Atul A
Harvard School of Public Health, Department of Health Policy and Management, Boston, Massachusetts, USA.
Qual Saf Health Care. 2007 Apr;16(2):101-4. doi: 10.1136/qshc.2006.019851.
Delays and underreporting limit the success of hospital incident reporting systems, but little is known about the causes or implications of delayed reporting.
The authors examined 6880 incident reports filed by physicians and nurses for three years at a national university hospital in Japan and evaluated the lag time between each incident and the submission of a report.
Although physicians and nurses reported nearly equal numbers of events resulting in major injury (32 v 31), physicians reported far fewer minor incidents (430 v 6387) and far fewer incidents overall (462 v 6418). In univariate analyses, lag time was significantly longer for physicians than nurses (3.79 v 2.20 days; p<0.001). In multivariate analysis, physicians had adjusted reporting lag time 75% longer than nurses (p<0.001) and lag time for major injuries was 18% shorter than for minor injuries (p = 0.011). Adjusted lag time in 2002 and 2004 were 34% longer than in 2003 (p<0.001).
Physicians report fewer incidents than nurses and take longer to report them. Quantitative evaluation of lag time may facilitate improvements in incident reporting systems by distinguishing institutional obstacles to physician reporting from physicians' lesser willingness to report.
延误和报告不足限制了医院事件报告系统的成效，但对于延误报告的原因或影响却知之甚少。
作者审查了日本一所国立大学医院的医生和护士在三年间提交的6880份事件报告，并评估了每个事件与报告提交之间的间隔时间。
尽管医生和护士报告导致重伤的事件数量相近（32起对31起），但医生报告的轻伤事件要少得多（430起对6387起），总体报告的事件也少得多（462起对6418起）。在单变量分析中，医生的报告间隔时间显著长于护士（3.79天对2.20天；p<0.001）。在多变量分析中，医生经调整后的报告间隔时间比护士长75%（p<0.001），重伤事件的间隔时间比轻伤事件短18%（p = 0.011）。2002年和2004年经调整后的间隔时间比2003年长34%（p<0.001）。
医生报告的事件比护士少，且报告时间更长。对间隔时间进行定量评估，通过区分阻碍医生报告的制度障碍和医生较低的报告意愿，可能有助于改进事件报告系统。
