Medical Residents’ Safety Reporting Remains Low, But Simple Steps by Medical Schools and Hospitals Could Help Increase Rates

B-school study explores factors affecting residents’ safety communication; proposes academic and operational solutions

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Feb 1, 2010

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NASHVILLE – According to a just-released, large-sample study, the extent to which medical residents -- physicians in training -- are involved in reporting safety incidents is limited, indicating a need for more institutional focus about how, when, why and where incidents should be reported.

The study was conducted at a major medical center in the Midwest, with the intent to explore whether residents are well trained in reporting safety incidents and the hope that the findings would indicate how to do a better job in the future, according to Rangaraj Ramanujam of Vanderbilt Owen Graduate School of Management, who co-authored the study with Lia Logio, MD, of Indiana University School of Medicine (IUSM).

Their findings were reported in an article, “Medical Trainees’ Formal and Informal Incident Reporting Across a Five-Hospital Academic Medical Center,” which appeared in the January 2010 issue of The Joint Commission Journal on Quality and Patient Safety.

Ramanujam applauded IUSM’s desire to better understand and improve on incident reporting among medical residents. “The underlying goal for the study is to get at what can we do to train physicians to become more engaged from the get-go in the process of continuous improvement in patient safety,” he said.

The good news is that that the researchers were able to recommend a number of steps to improve incident reporting by residents, from intensive role modeling by faculty to regularly informing residents about improvements resulting from incident reporting (see sidebar).

However, medical residents often lack knowledge of how to formally report safety incidents, which, the researchers point out, are not all medical errors. (Incidents could range from patient care that was not as intended to occurrences that were simply inconsistent with routine.) Further, even when residents did know how to file a formal report, they did so at lower than desired rates (38 and 42 percent, respectively, of more than 400 participants in each survey)

On the positive side, the study found that residents frequently discussed safety incidents with peers and some faculty on an informal basis, demonstrating awareness that even small incidents merit attention.

The study involved two online surveys of more than 900 medical residents and fellows as they rotated among five IUSM-affiliated hospitals, including a large community hospital; a university referral hospital with expertise in tertiary care; a well-known children’s hospital; a VA hospital and a public county facility. The study, the largest of its kind, is also among the first to explore whether and how residents’ reporting behaviors change as they move among hospitals.

According to Ramanujam, a key way to involve more residents in the process of improving patient safety is for academic training to emphasize and encourage such engagement. At the same time, the study found that residents’ reporting behaviors also seem to be shaped by unique attributes of different hospitals – even within the same academic center. Therefore, individual hospitals must also encourage residents to report incidents and emphasize their role in improving the whole system. Finally, he added, academic centers need to find a way to talk with hospitals about the specific behaviors that they’d especially like to encourage in their residents during rotational training.

“The findings are important in an era of health care reform. While the main impact of better incident reporting by residents will be seen once they move along in their careers and have more responsibility for safe patient care, it will also mean fewer mistakes that can be costly for patient safety and the bottom line,” Ramanujam said. “Some of the reasons residents don’t report more incidents are mundane. So the proposed solutions are simple but their long-term effects are potentially profound.”

Vanderbilt Owen Graduate School of Management is ranked as a top institution by BusinessWeek, the Wall Street Journal, U.S. News & World Report, Financial Times and Forbes. For more information about Owen, visit www.owen.vanderbilt.edu.