When medical errors occur, they may not be reported immediately. Physicians are particularly resistant to reporting adverse events to administrators, feeling they are not responded to in a timely manner. Preventing lag times in reporting is important to avoid further harm to the patient and to rapidly deploy an organizational response to the event. Given that institutional cultures often influence timely reporting, researchers studied incident-reporting systems at two academic medical centers in the United States and Japan. They found that lag times were three times longer at a Japanese hospital and were longer for physicians compared with other providers.
The academic medical center selected for study in Japan has 1,240 beds and is located in Kyoto. Since 2002, the hospital has had an established Patient Safety Division. The American hospital has 747 acute-care inpatient beds and is located in Boston. Their Risk Management Department oversees the incident-reporting system. Researchers collected incident reports from both medical centers during a 16-month period. Lag time was defined as the time between the date of the medical error and the date the primary report was received.
A total of 4,102 reports came from the U.S. hospital and 3,084 reports from the Japanese hospital. Among persons reporting, physicians were a small minority: only 3.7 percent in the United States and 5.3 percent in Japan. However, when physicians did report an event, it was more likely to be a major incident. Among the 18 major incidents reported from Japan, 12 occurred after invasive or diagnostic procedures, 4 were postoperative surgical events, and 2 were medication errors. There were only four major events reported from the U.S. hospital distributed among the three above categories and "other." Mean lag times were much shorter in the U.S.: 1.0 day compared with 3.1 days in Japan. Overall, physicians took 3.6 days to report an event compared with just 1.8 days for other providers.
The researchers point to lag times as a valuable measure of performance for reporting systems and as a way to understand barriers and promote compliance. The study was supported in part by the Agency for Healthcare Research and Quality (T32 HS00020).
See "A comparative analysis of incident reporting lag times in academic medical centres in Japan and the USA," by Scott E. Regenbogen, M.D., M.P.H., M. Hirose, M.D., Ph.D., Dr.P.H., Yuichi Imanaka, M.D., Ph.D., Dr.P.H., and others in Quality & Safety in Health Care 19(e10), pp. 1-4, 2010.