title: New legal protections for reporting patient errors under the Patient Safety and Quality Improvement Act: a review of the medical literature and analysis.
abstract: OBJECTIVE
  The Patient Safety and Quality Improvement Act (PSQIA) of 2005, inspired by the Institute of Medicine's (IOM) 1999 report To Err Is Human, affords federal protections in exchange for error disclosures. However, the PSQIA is unlikely to be effective unless frontline providers are aware of its existence. In this study, we assessed the quantity of publications regarding this protection within the medical literature.
  
  
  METHODS
  Four reviewers independently evaluated 2060 safety-related articles, identified through a PubMed database search, to determine whether they discussed actual (or proposed) national legal protections for voluntary reporting of medical errors. Using a reviewer method based on a standard Delphi consensus model, agreement was achieved if at least 3 of 4 reviewers agreed with the decision.
  
  
  RESULTS
  Articles were separated into pre-IOM report (1990-1999) and post-IOM report (2000-2008) literature. No articles were determined to be "on topic" in the pre-IOM period (n = 624). Twenty-seven articles were considered "on topic" in the post-IOM period (n = 1436), constituting 1.8% of the period total (95% confidence interval, 1.2%-2.6%). Of the 27 on topic articles, 7 appeared in practice-related journals, whereas the remaining 20 were in journals with a health policy or health care administration focus.
  
  
  CONCLUSIONS
  Few published studies were found in clinical journals describing the PSQIA. This raises serious concerns and indicates that physicians may not be aware of the new legal protections afforded for error disclosure. If the health care system is to realize the benefits of error reporting systems, greater education of physicians regarding their legal protections may be needed.
authors.affiliation: Department of Emergency Medicine, Johns Hopkins University School of Medicine, 5801 Smith Avenue, Baltimore, MD 21209, USA.
authors.forename: Jeff
authors.initials: J
authors.lastname: Howard
authors.forename: Fred
authors.initials: F
authors.lastname: Levy
authors.forename: Darren P
authors.initials: DP
authors.lastname: Mareiniss
authors.forename: Michelle
authors.initials: M
authors.lastname: Patch
authors.forename: Catherine K
authors.initials: CK
authors.lastname: Craven
authors.forename: Melissa
authors.initials: M
authors.lastname: McCarthy
authors.forename: Zachary Drew
authors.initials: ZD
authors.lastname: Epstein-Peterson
authors.forename: Victoria
authors.initials: V
authors.lastname: Wong
authors.forename: Peter
authors.initials: P
authors.lastname: Pronovost
mesh_terms: D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D019300:Medical Errors / Q000331:legislation & jurisprudence*; D015969:National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division; D010820:Physicians; D011640:Public Policy; D017751:Safety Management / Q000331:legislation & jurisprudence*; D014342:Truth Disclosure; D014481:United States