VOLUME 30, ISSUE 2

Confidential adverse event (AE) self-reporting improves patient safety. A “reporting culture” is a critical component of a safety culture; it encourages and facilitates the reporting of errors and safety issues1. This culture will enable organizations to understand safety issues and make improvements. Typically, reporting of AE’s can be an inefficient and cumbersome obstacle for physicians. High work production pressure, reduced patient care time, and inefficient electronic medical record (EMR) reporting interfaces impose increased time burdens for health care professionals: “Physician-driven EHR [modifications] … reduce the click burden in the EHR system [for] a more streamlined virtual workflow”2 We report a collaborative platform to facilitate physician efforts. At our institution, anesthesia care physicians partnered with information technology (IT) analysts to create a reporting system for adverse events, system issues, errors, and near misses.

The EMR was implemented in 2011 in the perioperative areas at Texas Children’s Hospital; however, all perioperative anesthetic AEs continued to be reported on paper, in an effort to maintain the confidentiality of the quality improvement (QI) process. Due to the fragmented process of dual electronic and paper documentation, a decrease in event reporting was observed. After evaluating other third-party solutions, our team ultimately designed a custom application that integrates and launches directly from the EMR. IT analysts developed this reporting system using an open-source software program, making it cost-effective and simple to maintain. The anesthetic EMR was redesigned to require a legally non-discoverable “Yes/No” reporting of adverse events for every anesthetic encounter. “Hard-stop close encounter checks” ensured that this documentation was entered before the record could be closed. The electronic reporting system enabled a seamless automated transfer of demographic and procedural data from the EMR to the incident report. The redesigned electronic QI reporting system provided a convenient and easy reporting process by which care providers reported near misses and system issues in addition to AE’s and errors. This information is stored in a separate, protected, encrypted database/server from the medical record to maintain legal protection of the QI data. The user-friendly electronic reporting system resulted in a four-fold increase in the number of submitted reports. The real-time data transfer allows for immediate access of reports by departmental QI personnel.

Along with the more comprehensive capture of important reports, the process alleviated the physician work burden. Smooth information integration frees the reporter to focus on the event and crucial details, thereby facilitating efficiency and work flow. This straightforward electronic incident reporting system enabled efficient and systematic data entry while providing physicians more patient care time in a fast-paced environment. This electronic reporting system increased reporting compliance, which ultimately improves patient safety. Institutions that desire improved QI reporting may develop this similarly as the application does not require any proprietary software purchase. Future plans include integrating this system into sedation procedures and developing an analytical platform to investigate trending errors and interrogate reports.