Reporting of adverse events.

From the Harvard School of Public Health, Boston. HEN the Institute of Medicine (IOM) issued To Err Is Human,1 the recommendation to expand reporting of serious adverse events and medical errors, particularly mandatory reporting, received the most attention and sparked controversy.2 The American Medical Association and the American Hospital Association raised strong objections, claiming that mandatory reporting would increase liability and drive reporting underground.3 Clearly, the report struck a nerve. Although the response of the American Medical Association reflected some confusion about the IOM’s advice — the call for mandatory reporting was directed at hospitals, not physicians — the discussion brought to the surface the unresolved conflict between the public’s desire for accountability and doctors’ and hospitals’ fear of damage to their reputations and of malpractice liability. But the IOM also called for expanded voluntary reporting, raising the hopes of those who seek to improve patient safety through greater sharing of information about errors and adverse events. According to the IOM, more than 1 million preventable adverse events occur each year in the United States, of which 44,000 to 98,000 are fatal.1 Although the accuracy of these numbers has been challenged,4-6 there is general agreement that the problem is serious. Because a greater understanding of the types of injuries and their causes is essential for the development of more effective methods of prevention, it seems evident that improved reporting of accidents and serious errors that do not cause harm (“close calls”) must be an essential part of any strategy to reduce injuries. Yet physicians have been reluctant partners in reporting.7 In this article, I examine the role of reporting in efforts to improve safety, assess the evidence that current reporting systems improve safety, review the characteristics of successful systems, and explore options for developing new reporting systems.