title: 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.
  
  
  METHODS
  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.
  
  
  METHODS
  The addition of a workflow-based response system to a reporting system processing incident reports and intra-hospital responses.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Information Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
authors.forename: Szu-Chang
authors.initials: SC
authors.lastname: Wang
authors.forename: Ying-Chun
authors.initials: YC
authors.lastname: Li
authors.forename: Hung-Chi
authors.initials: HC
authors.lastname: Huang
mesh_terms: D016001:Confidence Intervals; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008505:Medical Staff, Hospital; D061214:Patient Safety; D011446:Prospective Studies; D012308:Risk Management / Q000458:organization & administration / Q000706:statistics & numerical data*; D013624:Taiwan; D035141:Voluntary Programs / Q000458:organization & administration / Q000706:statistics & numerical data*; D057188:Workflow