Error reporting

Innovations

Monthly Multidisciplinary Patient Safety Conferences Improve Hospital Staff Perceptions of Organization's Safety Culture and Increase Reporting of Adverse Events 02/09/10

Monthly patient safety conferences that allow clinicians and all levels of staff to openly discuss adverse events improved staff perceptions of the organization's safety culture and increased the reporting of such events.

Proactive Reporting, Investigation, Disclosure, and Remedying of Medical Errors Leads to Similar or Lower Than Average Malpractice Claims Costs 12/14/09

A medical center adopted a comprehensive process that includes proactive reporting and investigation of potential errors, full disclosure and apology when errors occur, and fair remedy and compensation, leading to similar or lower than average claims costs.

Improvement Projects Led by Unit-Based Teams of Nurse, Physician, and Quality Leaders Reduce Infections, Lower Costs, Improve Patient Satisfaction, and Nurse–Physician Communication 12/04/09

Unit-based teams of physicians, nurses, and quality leaders develop and implement unit-specific initiatives designed to improve quality and safety, leading to reductions in infections and pressure ulcers, increased adherence to medication reconciliation standards, more reporting of errors and near-misses, higher patient satisfaction, and better overall nurse/physician communication and teamwork.

Full Disclosure of Medical Errors Reduces Malpractice Claims and Claim Costs for Health System 10/03/09

A multifaceted process for full disclosure of medical errors leads to a significant reduction in claims and claim costs for a health system.

Comprehensive Program to Promote "Fair and Just Principles" Improves Employee Perceptions of How a Health System Responds to Errors 06/24/09

A comprehensive program to promote adoption of a “fair and just” culture improves employee perceptions of how a health system responds to errors.

Safety Mentors Create Culture To Reduce Adverse Events and Increase Error Reporting 08/25/08

Safety mentors at Christiana Care Health System help staff implement best-practice safety behaviors and reporting of errors and near misses, leading to a reduction in serious adverse events and increased identification and/or reporting of near misses.

Voluntary System to Report and Analyze Nursing Errors Leads to Patient Safety Improvements 08/12/08

The Healthcare Alliance Safety Partnership was a 3-year pilot project involving a board of nursing and three hospital systems in developing a voluntary, nonpunitive system for reporting, investigating, and analyzing nursing errors.

Common Cause Analysis: A Hospital's Review of Vulnerabilities During Which Common Themes Are Identified, Prioritized, and Addressed 05/08/08

A children's hospital annually reviews all findings from root cause analysis to identify and address common themes and vulnerabilities, leading to a number of institutionwide changes that have improved patient safety and to better communication about safety issues with organizational leaders.

Voluntary Error Reporting Program Focusing on Systems Issues Increases Reporting and Contributes to Reduction in Liability Claims at Outpatient Clinic 04/03/08

A hospital outpatient clinic's confidential, voluntary error reporting system, which focuses on identifying faulty systems instead of individual mistakes, has substantially increased error reports and has been associated with a reduction in liability claims.

Voluntary, Anonymous, Non-Punitive System Leads to a Significant Increase in Reporting of Errors in Ambulatory Pediatric Practice 03/13/08

A hospital's ambulatory pediatrics department developed a voluntary, anonymous, and nonpunitive medical error reporting system that includes a quick response team to review reports and enact interventions to prevent recurrences, leading to a significant increase in error reporting.

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