This study covers identification of the high-risk areas in the hospital and the importance of incident reporting from medical doctors. The most frequently reported departments are not "dangerous departments", but "accident extraction power and transparency", which should be highly evaluated.
Although the incident reporting system does not reflect the actual hospital-wide events in our centre, it is a worthwhile source of information from which to discover potential risks and attributable factors of a representative patient safety issue [3, 6]. In this system, events whose potential consequences are difficult to measure in patient prognosis and which have been caused by external events or inappropriate or defective internal processes, systems, and/or systemic improvement activity are also indicated as risks. Accumulation of near-miss incidents of the same type and with a small impact as a one-off event also carries the risk of potential adverse events. There is a positive correlation between the number of incident reports and improved safety culture within the organization . Our hospital is a leading centre in regard to the number of incident reports (Fig. 1) in Japan. Adverse events reported by medical doctors helps to coordinate the treatment of severe and chronic injury and is important for continued transparency and active reporting in the hospital. Certain specialties have reported more near misses than others, and doctors have reported more harm incidents than near misses,7 in line with our present results (Fig. 2). According to another study, events with no harm to the patient represented a high percentage of all incident reports from nurses, other healthcare providers, and other workers . We assessed the various factors involved using a Pareto chart, the purpose of which is to highlight the most important among a large set of factors. The major issue hospital-wide (Fig. 3A) and among nurses (Fig. 3C) is medication errors, while for doctors operation-related matters are of greatest concern (Fig. 3B). Our aim is to target the outstanding issues and consider appropriate countermeasures for each incident, which can be complicated by many factors. The countermeasures should be comprehensive and practical. Furthermore, we investigated which department has risks with or without errors. Paediatrics and surgical departments are major sources of reported incidents (Fig. 4A). Paediatric patients are of varying age and carry a wide disease spectrum that can easily deteriorate. Healthcare providers should thus customize treatment for each patient with detailed assessment of the individual’s condition. Surgical departments obviously are sensitive to various risks during preoperative diagnosis, surgical procedures, and postoperative treatments. Our reporting standards include the occurrence of complications so that we can pick up on potential risks when there is a recurrent complication. As well as surgeons, anaesthesiologists face many challenging tasks and risks (Fig. 4B). Once again, bold and honourable reporting of incidents drives the safety culture and leads to organizational transparency in anaesthesiology. Overseeing measures to assess the reduction or increase in near misses or adverse events is a useful approach to improve the effectiveness of an incident-reporting system. Incident-reporting analyses demonstrate two influential factors, systemic issues and human errors. To reduce the hospital-wide risk, prompt, correct, and fair incident reporting is mandatory for improvement in healthcare.
In conclusion, reporting of incidents by medical doctors reflects the organizational transparency and the drive toward patient safety and quality improvement in healthcare. In addition, the reporting of near-miss events hospital-wide also assumes importance because they are the sentinel for future adverse events. After identifying the high-risk areas in various clinical departments, the next step should be to analyse the root cause of incidents, especially those reported by doctors, and intervene appropriately to improve the quality of healthcare. This should contribute directly to safer care and the overall drive toward the enforcement of a culture of patient safety in the hospital. We can say that reports from doctors are overwhelmingly more severe than reports from other occupations. This means that hospitals cannot accurately ascertain adverse events unless there are few reports from doctors. As a safety manager, we want to clear adverse events as much as possible, and to respond to particularly serious adverse events by collecting the best of the hospital. Nurses can report many attempted and harmless cases, minor cases such as abrasions and bruises, but that alone is not enough. Our hospital is grasping the overall picture of adverse events due to the increase in reports from doctors, and feels that we can finally stand at the starting point of medical safety.
This study is limited by the fact that it is not designed to assess the effectiveness of incident reporting and actions to improve the safety culture. However, reporting by medical doctors reflects the organizational transparency and dynamic efforts required for patient safety and quality improvement in healthcare. Efforts to achieve seamless improvement in patient safety and care at our hospital will continue.