Value of Incident Reporting to Address Real-time Safety Opportunities During the COVID-19 Pandemic.

IF 1.7 3区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Journal of Patient Safety Pub Date : 2025-08-01 Epub Date: 2025-04-08 DOI:10.1097/PTS.0000000000001344
Pamela S Roberts, Nandita Raman, Brandi Rico, Edward Seferian
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Abstract

Objectives: A strong safety culture encourages staff to identify and report safety events and near misses through an incident reporting system. The objectives were to: (1) assess the effectiveness of real-time reporting of safety events for timely identification of trends and improvement opportunities in a rapidly changing environment and (2) determine temporal changes in safety event categories throughout the 4 COVID-19 pandemic waves in Southern California.

Methods: This retrospective study involved all safety incidents reported in patients over age 18 related to the care of COVID-19 through the hospital's incident reporting system, CS-Safe from March 17, 2020 to February 25, 2022.

Results: There were 5843 suspected and confirmed COVID-19 cases across the 4 waves. The reported events primarily were associated with patients between the ages of 65 and 84 years, with the majority (62.7%) male, white (65.4%), and non-Hispanic (73.5%). Most events reported were related to clinical care issues (41.6%). A difference in the rates of safety incidents was observed across the waves. The highest rate of medication management-related safety incidents was in wave 2 (0.25 incidents/1000 d) and the highest rate of incidents occurred in critical care in wave 3 (1.20 incidents/1000 d).

Conclusions: The alignment of COVID-19-related safety incidents across the 4 waves with the occurrences during this time demonstrates the value of real-time reporting in identifying trends and opportunities for improvement in a rapidly changing environment. Hence, real-time assessment of events can be valuable in concurrently addressing demands during unprecedented situations.

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在 COVID-19 大流行期间,事件报告对把握实时安全机遇的价值。
目标:一个强大的安全文化鼓励员工通过事故报告系统识别和报告安全事件和未遂事件。目标是:(1)评估安全事件实时报告的有效性,以便在快速变化的环境中及时识别趋势和改进机会;(2)确定南加州4波COVID-19大流行期间安全事件类别的时间变化。方法:本回顾性研究纳入了2020年3月17日至2022年2月25日期间通过医院事件报告系统CS-Safe报告的所有18岁以上患者与COVID-19护理相关的安全事件。结果:4波共发现疑似和确诊病例5843例。报告的事件主要与65至84岁之间的患者相关,大多数(62.7%)为男性,白人(65.4%)和非西班牙裔(73.5%)。报告的大多数事件与临床护理问题有关(41.6%)。安全事故的发生率在各个海浪中都有所不同。与药物管理相关的安全事件发生率最高的是第2波(0.25例/1000 d),第3波发生在重症监护中的事件发生率最高(1.20例/1000 d)。结论:4波中与covid -19相关的安全事件与此期间发生的事件的一致性表明了实时报告在快速变化的环境中识别趋势和改进机会的价值。因此,对事件的实时评估对于在前所未有的情况下同时处理需求是很有价值的。
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来源期刊
Journal of Patient Safety
Journal of Patient Safety HEALTH CARE SCIENCES & SERVICES-
CiteScore
4.60
自引率
13.60%
发文量
302
期刊介绍: Journal of Patient Safety (ISSN 1549-8417; online ISSN 1549-8425) is dedicated to presenting research advances and field applications in every area of patient safety. While Journal of Patient Safety has a research emphasis, it also publishes articles describing near-miss opportunities, system modifications that are barriers to error, and the impact of regulatory changes on healthcare delivery. This mix of research and real-world findings makes Journal of Patient Safety a valuable resource across the breadth of health professions and from bench to bedside.
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