title: Clinical factors associated with the non-utilization of an anaesthesia incident reporting system.
abstract: BACKGROUND
  Incident reporting is a widely recommended method to measure undesirable events in anaesthesia. Under-utilization is a major weakness of voluntary incident reporting systems. Little is known about factors influencing reporting practices, particularly the clinical environment, anaesthesia team composition, severity of the incident, and perceived risk of litigation. The purpose of this study was to assess each of these, using an existing anaesthesia database.
  
  
  METHODS
  We performed a retrospective cohort study and analysed 46 207 surgical patients. We used multivariate analysis to identify factors associated with the non-utilization of the reporting system.
  
  
  RESULTS
  We found that in 7022 (15.1%) of the procedures performed, the incident reporting system was not used. Factors associated with the non-use of the system were regional anaesthesia/local anaesthesia, odds ratio (OR) 1.64 [95% confidence interval (CI) 1.03-2.62], emergency procedures OR 1.15 (95% CI: 1.05-1.27), and a consultant anaesthetist working without a trainee, OR 1.71 (95% CI: 1.03-2.82). In contrast, factors such as longer duration of surgery, OR 0.85 (95% CI: 0.76-0.94), the presence of a senior anaesthesia trainee, OR 0.86 (95% CI: 0.81-0.92), and the occurrence of severe complications with a high risk of litigation (i.e. death, nerve injuries) were less associated with a non-use of the reporting system, OR 0.65 (95% CI: 0.44-0.97). Team composition and time of day had no measurable impact on reporting practices.
  
  
  CONCLUSIONS
  Clinical factors play a significant role in the utilization of an anaesthesia incident reporting system and more particularly, severity of complications and higher liability risks which appear more as incentives than barriers to incident reporting.
authors.affiliation: Department of Anesthesia, Pharmacology and Intensive Care, Geneva University Hospitals, University of Geneva, 4, rue Perret-Gentil, 1211 Genève 14, Switzerland. guy.haller@hcuge.ch
authors.forename: G
authors.initials: G
authors.lastname: Haller
authors.forename: D S
authors.initials: DS
authors.lastname: Courvoisier
authors.forename: H
authors.initials: H
authors.lastname: Anderson
authors.forename: P S
authors.initials: PS
authors.lastname: Myles
mesh_terms: D000328:Adult; D000368:Aged; D000758:Anesthesia / Q000009:adverse effects* / Q000379:methods; D000776:Anesthesiology / Q000331:legislation & jurisprudence; D002983:Clinical Competence; D003253:Consultants; D004630:Emergencies; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008318:Malpractice / Q000331:legislation & jurisprudence; D008875:Middle Aged; D012308:Risk Management / Q000379:methods / Q000706:statistics & numerical data*; D013997:Time Factors; D014739:Victoria