Journal of General Internal Medicine

, Volume 15, Issue 7, pp 470–477 | Cite as

Confidential clinician-reported surveillance of adverse events among medical inpatients

  • Saul N. WeingartEmail author
  • Amy N. Ship
  • Mark D. Aronson
Original Articles


BACKGROUND: Although iatrogenic injury poses a significant risk to hospitalized patients, detection of adverse events (AEs) is costly and difficult.

METHODS: The authors developed a confidential reporting method for detecting AEs on a medicine unit of a teaching hospital. Adverse events were defined as patient injuries. Potential adverse events (PAEs) represented errors that could have, but did not result in harm. Investigators interviewed house officers during morning rounds and by e-mail, asking them to identify obstacles to high quality care and iatrogenic injuries. They compared house officer reports with hospital incident reports and patients’ medical records. A multivariate regression model identified correlates of reporting.

RESULTS: One hundred ten events occurred, affecting 84 patients. Queries by e-mail (incidence rate ratio [IRR]=0.16; 95% confidence interval [95% CI], 0.05 to 0.49) and on days when house officers rotated to a new service (IRR=0.12; 95% CI, 0.02 to 0.91) resulted in fewer reports. The most commonly reported process of care problems were inadequate evaluation of the patient (16.4%), failure to monitor or follow up (12.7%), and failure of the laboratory to perform at test (12.7%). Respondents identified 29 (26.4%) AEs, 52 (47.3%) PAEs, and 29 (26.4%) other house officer-identified quality problems. An AE occurred in 2.6% of admissions. The hospital incident reporting system detected only one house officer-reported event. Chart review corroborated 72.9% of events.

CONCLUSIONS: House officers detect many AEs among inpatients. Confidential peer interviews of front-line providers is a promising method for identifying medical errors and substandard quality.

Key words

Adverse event medical error house officer 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Brennan TA, Leape LL, Laird NM et al. Incidence of adverse events and negligence in hospitalized patients. New Engl J Med. 1991;324:370–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Leape LL, Brennan TA, Laird N et al. The nature of adverse events in hospitalized patients. New Engl J Med. 1991;324:377–84.PubMedCrossRefGoogle Scholar
  3. 3.
    Andrews LB, Stocking C, Krizek T et al. An alternative strategy for studying adverse events in medical care. Lancet. 1997;349:309–13.PubMedCrossRefGoogle Scholar
  4. 4.
    Bates DW, Spell N, Cullen DJ, et al. The costs of adverse drug events in hospitalized patients. JAMA. 1997;277:307–11.PubMedCrossRefGoogle Scholar
  5. 5.
    Bates DW, Cullen DJ, Laird N, et al. Incidence of adverse drug events and potential adverse drug events. JAMA. 1995;274:29–34.PubMedCrossRefGoogle Scholar
  6. 6.
    Cullen DJ, Bates DW, Small SD, et al. The incident reporting system does not detect adverse drug events: A problem for quality improvement. Jt Comm J Qual Improv. 1995;21:541–52.PubMedGoogle Scholar
  7. 7.
    Iezzoni LI, Daley J, Heeren T, et al. Using administrative data to screen hospitals for high complication rates. Inquiry. 1994;31:40–55.PubMedGoogle Scholar
  8. 8.
    Iezzoni LI, Daley J, Heeren T, et al. Identifying complications of care using administrative data. Med Care. 1994;32:700–15.PubMedCrossRefGoogle Scholar
  9. 9.
    Classen DC, Pestotnik SL, Evans RS, et al. Computerized surveillance of adverse drug events in hospital patients. JAMA. 1991;266:2847–51.PubMedCrossRefGoogle Scholar
  10. 10.
    Bates DW, Leape LL, Cullen DJ, et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA. 1998;280:1311–5.PubMedCrossRefGoogle Scholar
  11. 11.
    Weingart SN. House officer education and organizational obstacles to quality improvement. Jt Comm J Qual Improv. 1996;22:640–6.PubMedGoogle Scholar
  12. 12.
    Wu AW, Folkman S, McPhee SJ, et al. Do house officers learn from their mistakes? JAMA. 1991;265:2089–94.PubMedCrossRefGoogle Scholar
  13. 13.
    Welsh CH, Pedot RP, Anderson RJ. Use of morning report to enhance adverse event detection. J Gen Intern Med. 1996;11:454–60.PubMedCrossRefGoogle Scholar
  14. 14.
    O’Neil AC, Petersen LA, Cook F et al. Physician reporting compared with medical-record review to identify adverse medical events. Ann Intern Med. 1993;119:370–6.PubMedGoogle Scholar
  15. 15.
    Leape LL, Bates DW, Cullen DJ, et al. Systems analysis of adverse drug events. JAMA. 1995;274:35–43.PubMedCrossRefGoogle Scholar
  16. 16.
    Caplan RA, Posner KL, Cheney FW. Effect of outcome on physician judgments of appropriateness of care. JAMA. 1991;265:1957–60.PubMedCrossRefGoogle Scholar
  17. 17.
    Leape LL. Error in medicine. JAMA. 1994;272:1851–7.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2000

Authors and Affiliations

  • Saul N. Weingart
    • 2
    • 1
    Email author
  • Amy N. Ship
    • 2
    • 1
  • Mark D. Aronson
    • 2
    • 1
  1. 1.Department of MedicineHarvard Medical SchoolBoston
  2. 2.Division of General Medicine and Primary CareBeth Israel Deaconess Medical CenterBoston

Personalised recommendations