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A Survey of Physicians in Teaching Hospitals

Lauris C. Kaldjian, MD, PhD; Elizabeth W. Jones, MHSA; Barry J. Wu, MD; Valerie L. Forman-Hoffman, PhD, MPH; Benjamin H. Levi, MD, PhD; Gary E. Rosenthal, MD

Arch Intern Med. 2008;168(1):40-46.

Background  Collecting data on medical errors is essential for improving patient safety, but factors affecting error reporting by physicians are poorly understood.

Methods  Survey of faculty and resident physicians in the midwest, mid-Atlantic, and northeast regions of the United States to investigate reporting of actual errors, likelihood of reporting hypothetical errors, attitudes toward reporting errors, and demographic factors.

Results  Responses were received from 338 participants (response rate, 74.0%). Most respondents agreed that reporting errors improves the quality of care for future patients (84.3%) and would likely report a hypothetical error resulting in minor (73%) or major (92%) harm to a patient. However, only 17.8% of respondents had reported an actual minor error (resulting in prolonged treatment or discomfort), and only 3.8% had reported an actual major error (resulting in disability or death). Moreover, 16.9% acknowledged not reporting an actual minor error, and 3.8% acknowledged not reporting an actual major error. Only 54.8% of respondents knew how to report errors, and only 39.5% knew what kind of errors to report. Multivariate analyses of answers to hypothetical vignettes showed that willingness to report was positively associated with believing that reporting improves the quality of care, knowing how to report errors, believing in forgiveness, and being a faculty physician (vs a resident).

Conclusion  Most faculty and resident physicians are inclined to report harm-causing hypothetical errors, but only a minority have actually reported an error.

Author Affiliations: Division of General Internal Medicine, Department of Internal Medicine (Drs Kaldjian, Forman-Hoffman, and Rosenthal and Ms Jones) and Program in Biomedical Ethics and Medical Humanities (Dr Kaldjian), University of Iowa Roy J. and Lucille A. Carver College of Medicine, and Center for Research in the Implementation of Innovative Strategies in Practice, Iowa City Veterans Affairs Medical Center (Drs Kaldjian, Forman-Hoffman, and Rosenthal and Ms Jones), Iowa City; Departments of Internal Medicine, Hospital of St Raphael and Yale University School of Medicine, New Haven, Connecticut (Dr Wu); and Departments of Humanities and Pediatrics, Penn State College of Medicine and Hershey Medical Center, Hershey, Pennsylvania (Dr Levi). Ms Jones is now with the Virginia Department of Social Services, Richmond.