The effect of a workflow-based response system on hospital-wide voluntary incident reporting rates

Abstract

Background. Hospital incident reporting systems are usually evaluated on their theoretical benefit to the hospital or increase in reporting rates alone. Objective. To evaluate a workflow-based response system on staff incident reporting rates. Design, Setting and Participants. A prospective cohort study of incident reports made by staff members before (2006-2007) and after (2008-2009) the system was implemented on 1 January 2008 at a medical center in southern Taiwan. Pre-system and post-system data were based on 713 129 and 730 176 inpatient days and 160 692 and 168 850 emergency department visits. Intervention. The addition of a workflow-based response system to a reporting system processing incident reports and intrahospital responses. Main Outcome Measures. Voluntary incident reporting rates and distribution of incident severities. Results. Inpatient reports [9.9 vs. 28.8 per 10 000 patient days; rate ratio (RR): 2.9, 95% confidence interval (CI): 2.7-3.2, P < 0.001] and emergency department reports (5.9 vs. 19.2 per 10 000 visits, RR: 3.3, 95% CI: 2.6-4.1, P < 0.001) increased significantly, particularly in doctors in inpatient areas (RR: 2.7, 95% CI: 1.8-4.1, P < 0.001), emergency department nurses (RR: 9.4, 95% CI: 6.1-14.4, P < 0.001) and allied health professionals in inpatient areas (RR: 2.2, 95% CI:1.8-2.6, P < 0.001). Post-system reported incidents were more evenly distributed over five severity levels than pre-sytem incidents, moving more toward the very severe level (RR: 17.6, 95% CI: 8.4-37.0, P < 0.001) and no harm level (RR: 6.2, 95% CI: 4.5-8.7, P < 0.001). Conclusion. The addition of the workflow-based response system to the hospital incident reporting system significantly increased hospital-wide voluntary incident report rates at all incident injury levels. © The Author 2012. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.