Logio Lia S, Ramanujam Rangaraj
Indiana University School of Medicine, Indianapolis, Indiana, USA.
Jt Comm J Qual Patient Saf. 2010 Jan;36(1):36-42. doi: 10.1016/s1553-7250(10)36007-7.
Despite the importance of incident reporting for promoting patient safety, the extent to which residents and fellows (trainees) in graduate medical education (GME) programs report incidents is not well understood. A study was conducted to determine the prevalence of and variations in incident reporting across hospitals in an academic medical center.
Trainees enrolled in GME programs sponsored by the Indiana University School of Medicine (IUSM) completed (1) the Behavior Index Survey (BIS), which asked respondents if they knew how to locate incident forms and if they ever submitted an incident form, and (2) the Safety Culture Survey (SCS), which asked about the frequencies of their formal and informal incident reporting behaviors.
Some 443 of 992 invited trainees (45% response rate) participated in the study. Of the 305 BIS respondents who rotated through all five hospitals, varying proportions knew how to locate an incident form (22.3%-31.5%) and had completed an incident form (6.2%-20%) in each hospital. Incident report completion rates were higher (20.1%-81.3%) among trainees who knew how to locate an incident form. Higher proportions of the 443 SCS respondents had informally discussed an incident with other trainees (90%), faculty physicians (70%), and at resident meetings and conferences (73%).
The study confirms that GME trainees formally report incidents rarely. The flow of communication to and from trainees about patient safety and incidents is low, despite an organizational focus on safety and quality. Discussion of safety issues among trainees occurs more informally among colleagues and peers than with faculty or through formal reporting mechanisms. The data suggest a number of strategies to increase the culture of safety among GME trainees.
尽管事件报告对于促进患者安全至关重要，但研究生医学教育（GME）项目中的住院医师和研究员（实习生）报告事件的程度尚未得到充分了解。开展了一项研究以确定学术医疗中心各医院事件报告的发生率及差异。
参加印第安纳大学医学院（IUSM）赞助的GME项目的实习生完成了：（1）行为指数调查（BIS），询问受访者是否知道如何找到事件报告表以及他们是否曾提交过事件报告表；（2）安全文化调查（SCS），询问他们正式和非正式事件报告行为的频率。
992名受邀实习生中有约443人（回复率45%）参与了研究。在305名在所有五家医院轮转的BIS受访者中，每家医院知道如何找到事件报告表的比例各不相同（22.3%-31.5%），且完成事件报告表的比例也不同（6.2%-20%）。在知道如何找到事件报告表的实习生中，事件报告完成率更高（20.1%-81.3%）。443名SCS受访者中，有更高比例的人曾与其他实习生（90%）、指导医师（70%）以及在住院医师会议上非正式讨论过事件（73%）。
该研究证实GME实习生很少正式报告事件。尽管组织关注安全和质量，但与实习生之间关于患者安全和事件的沟通交流很少。实习生之间关于安全问题的讨论在同事和同龄人之间比与指导教师或通过正式报告机制更为频繁。数据表明了一些提高GME实习生安全文化的策略。
