Barriers to and incentives for safety event reporting in emergency departments

Patient safety events (PSEs) are common in healthcare and may be particularly prevalent in complex care settings such as emergency departments (EDs). Systems for reporting, analyzing, learning from and responding to incidents are promoted as a means to reduce adverse events by facilitating feedback, learning and system change. However, only 4-50% of PSEs are reported. Under-reporting masks the true number of PSEs and may reduce our ability to learn from and prevent repeat events. The goal of this study was to identify barriers that prevent PSE reporting and incentives that encourage reporting. Semi-structured interviews were carried out with front-line nursing staff and nurse managers in EDs across British Columbia to explore their perception of barriers to and incentives for PSE reporting. Interviews were recorded, transcribed, checked for accuracy and entered into NVivo 8 software. Data were analyzed thematically as they were acquired, and emerging themes were explored in subsequent interviews. One hundred six interviews were conducted with staff from 94 of the 98 EDs in British Columbia. Six main barriers to PSE reporting were identified: (1) time constraints, (2) a sense of futility, (3) fear of reprisal, (4) a lack of education on PSE reporting, (5) reports being viewed as indicators of incompetence and (6) an inaccessibility of reporting forms. Incentives for reporting included valuing PSE reporting, the availability of alternative reporting pathways and feedback and visible changes resulting from PSE reports. We identified barriers that restrain nurses from reporting PSEs and incentives that facilitate reporting. Our findings should be considered when developing systems to report and learn from PSEs.