Reporting of adverse events.

By Lucian Leape. New England Journal of Medicine, 2002

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Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, 2002 (2007, background): “Definitions An HAI was defined as a localized or systemic condition that (1) results from an adverse reaction to the presence of an infectious agent(s) or its toxin(s), (2) that occurs during a hospital admission, (3) for which there is no evidence the infection was present or incubating at admissio”
Detecting adverse events for patient safety research: a review of current methodologies (2003, background): “There are several important reasons why incident reporting in its current state may not be the most effective way to detect adverse events [22,23], including interruption in workflow, perception that completing a form will not result any improvement, lack of knowledge that an adverse event had occur”
The Critical Care Safety Study: The incidence and nature of adverse events and serious medical errors in intensive care* (2005, background): “We found direct observation to be especially valuable in detecting near-misses, as they are far less frequently reported or documented in patient charts than adverse events (22).”
Patients' and physicians' attitudes regarding the disclosure of medical errors. (2003, background): “Mean y in practice (range) 16 (1-45) Male, No.”