title: Integrating incident data from five reporting systems to assess patient safety: making sense of the elephant.
abstract: BACKGROUND
  A study was conducted to examine and compare information gleaned from five different reporting systems within one institution: incident reporting, patient complaints, risk management, medical malpractice claims, and executive walk rounds. These data sources vary in the timing of the reporting (retrospective or prospective), severity of the events, and profession of the reporters.
  
  
  METHODS
  A common methodology was developed for classifying incidents. Data specific to each incident were abstracted from each system and then categorized using the same framework into one of 23 categories.
  
  
  RESULTS
  Overall, there was little overlap, although each reporting system identified important safety issues. Communication problems were common among patient complaints and malpractice claims; malpractice claims' leading category was clinical judgement. Walk rounds identified issues with equipment and supplies. Adverse event reporting systems highlighted identification issues, especially mislabelled specimens. The frequency of contributions of reports by provider group varied substantially by system. Physicians accounted for 50% of risk management reports, but in adverse event reporting, where nurses were the main reporters, physicians accounted for only 2.5% of reports. Complaints and malpractice claims come primarily from patients.
  
  
  CONCLUSIONS
  The five reporting systems each identified different yet complementary patient safety issues. To obtain a comprehensive picture of their patient safety problems and to develop priorities for improving safety, hospitals should use a broad portfolio of approaches and then synthesize the messages from all individual approaches into a collated and cohesive whole.
authors.affiliation: Division of General Internal Medicine, Brigham and Women's Hospital, Boston, USA.
authors.forename: Osnat
authors.initials: O
authors.lastname: Levtzion-Korach
authors.forename: Allan
authors.initials: A
authors.lastname: Frankel
authors.forename: Hanna
authors.initials: H
authors.lastname: Alcalai
authors.forename: Carol
authors.initials: C
authors.lastname: Keohane
authors.forename: John
authors.initials: J
authors.lastname: Orav
authors.forename: Erin
authors.initials: E
authors.lastname: Graydon-Baker
authors.forename: Janet
authors.initials: J
authors.lastname: Barnes
authors.forename: Kathleen
authors.initials: K
authors.lastname: Gordon
authors.forename: Anne Louise
authors.initials: AL
authors.lastname: Puopulo
authors.forename: Elena Ivanova
authors.initials: EI
authors.lastname: Tomov
authors.forename: Luke
authors.initials: L
authors.lastname: Sato
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
mesh_terms: D000046:Academic Medical Centers; D001291:Attitude of Health Personnel; D003625:Data Collection; D006801:Humans; D008318:Malpractice / Q000706:statistics & numerical data*; D019300:Medical Errors / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data*; D012308:Risk Management / Q000706:statistics & numerical data*; D017751:Safety Management / Q000706:statistics & numerical data*