gms | German Medical Science

Introduction: Patient safety has become a major topic and is going to receive more and more attention in health care. By now, several instruments exist to improve patient safety in hospitals, such as checklists or critical incident reporting systems (CIRS). CIRS is a structured digital reporting system originated in the field of risk management. It is designed to provide every health care professional with the opportunity to anonymously report near misses and errors. Although the CIRS data are freely available, only a few analyses of these data have been published so far [1], [2], [3]. Focusing on three subject areas (continuity of information, diversity, emergency department), the goal is to identify medical errors reported in CIRS regarding communication and especially the role of information continuity.

Methods: For the CIRS data analyses the records of the CIRSmedical.de were used. At the time of the final search (11-01-2018) 5,786 cases were registered in this database. Prior to the search a list of relevant keywords was defined. In a first step, all extracted cases were scanned for their relevance regarding the three subjects. Case descriptions that did not match the searched terms, only mentioned them briefly or were duplications were excluded. In the next step, the cases were examined with regard to the following information: problems, possible causes, influencing factors and options of resolution extracted. Afterwards, comprehensive categories and sub-categories were inductively generated by applying qualitative data analysis techniques.

Results: The subject continuity of information focuses on the distribution of information in the context of patient transfers. 335 cases were found, 73 included in the analyses. The following categories could be derived: dissemination of information (n=38), documentation (n=15), processes/standards (n=14) and medical equipment (n=6). Diversity deals with the influence of heterogenic groups on the hospital safety culture. 190 cases were found, 45 included. Regarding communication two main categories (mis-)communication (n=16) and (mal-)adaption to patient needs (n=28) emerged. The third pilot study emergency department addresses the interdisciplinary cooperation of the different professional groups in this organizational unit. 174 cases were found, 103 included. When focusing on the continuity of information the categories responsibilities (n=27), processes (n=29) and communication (n=23) appeared to be of particular importance.

Discussion: Communication and information continuity emerged in all three subjects as key risk factors for the occurrence of near misses and errors in the care of patients during their hospital stay. It has been shown that a CIRS database is useful for the analyses of problem fields. The implementation and use of a CIRS can contribute to improve the patient safety culture in hospitals. It provides the possibility to identify and clarify near misses and adverse events. This can result in inducing corrective measures and can enable the prevention of future events [4]. As a consequence, CIRS also helps to improve information continuity within the scope of establishing a safety culture. Nevertheless, it is a hint for a lack of competences in communication and continuity of information and the demand for the development of education and training in hospitals [5].

The authors declare that they have no competing interests.

The authors declare that an ethics committee vote is not required.