Eight-year longitudinal evaluation of an electronic patient safety reporting system in a public hospital

This paper aims to evaluate changes in reporting rates and notification timeliness following implementation of an electronic patient safety reporting system in a high-complexity public hospital over eight years.

A quasi-experimental before-after study without a control group analysed all eligible inpatient reports recorded from 2015 to 2022. The pre-implementation period was compared with the post-implementation period. Rates were calculated per 100 discharges and timeliness as notification days. A post hoc temporal sensitivity analysis compared pre-implementation, 2019 (pre-pandemic), 2020-2021 (early pandemic), and 2022 using Poisson rate ratios.

Among 14,017 reports, the rate increased from 3.47 to 13.37 per 100 discharges (RR 3.86, 95% CI 3.70-4.02). It had already reached 7.58 in 2019 (rate ratio 2.19, 95% confidence interval 2.06-2.32 versus pre-implementation), rose to 15.30 during 2020-2021, and remained 15.86 in 2022. Median notification time decreased from 9 to 1 day. The change therefore began before Coronavirus Disease 2019 (COVID-19) and persisted in 2022. The electronic system may have contributed, particularly to notification timeliness, but the design does not support causal attribution.

Separating temporal phases shows that the increase preceded COVID-19 and persisted in 2022. The findings are consistent with a possible contribution from electronic implementation, particularly to notification timeliness, while acknowledging that pandemic-related changes, increased safety awareness and previous underreporting may also have influenced reporting volume.