Presenter: Kamisha Hamilton Escoto, MSIE
Institution: University of Wisconsin-Madison
Co-Authors: Ben-Tzion Karsh, PhD, John Beasley, MD
Introduction: The purpose of this paper is to describe the preferences of family physicians and clinical assistants regarding the design of a statewide medical error reporting system in Wisconsin. Despite the high potential for errors to occur in primary care, attention to the design of an accurate system to capture errors in this setting has been limited. One of the ways to address this deficiency is to utilize a human factors engineering user-centered design paradigm. The research question for this study is "What are the barriers and motivators for the design of an error reporting system for capturing medical errors in primary care and what design features enable and motivate potential reporters to report?"
Methods: A human factors engineering user-centered design model was used for this study, employing a series of separate focus groups with both physicians and clinical assistants. Eight family physicians and six clinical assistants volunteered to participate. The study resulted in a total of 16 focus group meetings (7 clinical assistant, 9 physician – both groups covered the same topics) with a range of topics including system purposes, barriers and motivators for reporting, reporting content, and reporting medium to name a few. The focus group meetings took place by teleconference, were audio-taped and edited to remove any form of participant identification, and then subsequently transcribed for analysis. Qualitative methodologies were employed to analyze the data, including a content analysis of the focus group transcripts (Miles & Huberman 1984). Following the completion of the coding, the data were transformed into display format; namely a Process/Outcomes matrix (Patton, 2002).
Results and Discussion: The focus groups meetings yielded over 300 pages of transcribed text, 86 major and minor themes, and over 1000 coded passages. This paper will concentrate on results generated from thematic content pertaining to desired reporting content, motivators, barriers, and concerns in order to describe a sample of the issues that may affect reporter participation. Clinicians listed several items they would feel necessary to be included in the content of the reporting medium. Both adverse events and near misses were reasoned to be important to report. However, while the physicians felt strongly about near miss reporting for its learning potential, the clinical assistants felt that time would not be taken to report them, despite their value. The situational details of the occurrence was deemed important – including the basic who, what, when, and where; but also consisted of working conditions, e.g. call weekend, where in the shift it happened, number of hours worked, or mandatory overtime. Information surrrounding the relevance of tools and/or technologies employed during the occurence and their malfunction, or improper use were also mentioned as part of the situational variables. Some of the event analysis categories specified by the clinicians were contributing factors, preventive factors, mitigators, etc. Practical preventive measures, specifically, were desired that were feasible within the local care setting – possibly to lead to a database of preventive measures. The degree of identification in the system for both clinicians and patients were discussed. Regarding patients, the sentiment was that age and gender were important, and any other reported information should only be relevant to the situation, for instance if the patient was uncooperative. Much debate centered upon the degree of identification of the clinician in the system. Though the clinicians debated over particular demographics, the agreement was that factual information made up the most important piece of an error report, and that job title and experience level would be the farthest that clinicians would feel comfortable reporting. The general notion was that of personal protection primarily, but also taken into consideration was that too much information does not necessarily add to the quality of the report, but makes it more of a lengthy procedure. The preferred format of the reporting medium was a blend of checkboxes and free-flow narrative sections. Arguments existed for the inclusion of each option, and a compromise between the two would be necessary and highly useful. The preferred medium would need to be flexible with a range of options, including electronic, paper, phone or fax. The signficant message here being that having these options made the system consistently available – thus avoiding the problem of under-reporting due to lack of an available medium. Though the clinicians had various levels of comfort with computing devices, physicians liked the idea of having a portable, e.g. handheld system for reporting errors. Some of the major implications of creating and implementing a statewide error reporting system are integration with existing local reporting systems, and converting information obtained from various reporting mediums into a common format.
Straight From the User: Error Reporting System Guidelines
