Evaluation of a Web-based Error Reporting Surveillance System in a Large Iranian Hospital

Area of Science:

• Healthcare Quality Improvement
• Patient Safety Research
• Health Informatics

Background:

• Effective medical error reporting is crucial for learning from adverse events and enhancing patient safety.
• Web-based reporting systems offer comprehensive data for analysis, making them preferable to other methods.
• This study evaluates an in-house developed voluntary web-based medical error reporting system.

Purpose of the Study:

• To assess the impact of a voluntary web-based medical error reporting system on error detection and analysis.
• To evaluate the system's performance in generating timely and accurate follow-up reports.
• To determine the system's utility in identifying areas for system defect improvement.

Main Methods:

• An interventional study was conducted using a custom-designed voluntary web-based medical error reporting system.
• The system was implemented at Nemazee Hospital, Shiraz University of Medical Sciences, starting July 2014.
• Error rates and severity were compared for the year preceding and the year following the system's launch.

Main Results:

• The error reporting trend showed a significant increase in the first 12 months (B = 105.727, P = 0.00).
• Following the web-based system's implementation, the trend slowed and was no longer statistically significant (B = 15.27, P = 0.81).
• Most reported errors were no-harm laboratory incidents attributed to inattention, primarily reported by permanent staff during morning shifts.

Conclusions:

• A standardized web-based error reporting system offers significant benefits for medical error management.
• The in-house designed system effectively detected, analyzed, and reported medical errors, including near-misses.
• Identifying near-miss errors is vital for pinpointing and rectifying system defects to improve overall patient safety.