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  • Title: Patient-reported experiences of patient safety incidents need to be utilized more systematically in promoting safe care.
    Author: Sahlström M, Partanen P, Turunen H.
    Journal: Int J Qual Health Care; 2018 Dec 01; 30(10):778-785. PubMed ID: 29668942.
    Abstract:
    OBJECTIVE: To analyze patient safety incidents (PSIs) reported by patients and their use in Finnish healthcare organizations. STUDY DESIGN: Cross-sectional study. SETTING: About 15 Finnish healthcare organizations ranging from specialized hospital care to home care, outpatient and inpatient clinics, and geographically diverse areas of Finland. PARTICIPANTS: The study population included all Finnish patients who had voluntarily reported PSI via web-based system in 2009-15. MAIN OUTCOME MEASURE(S): Quantitative analysis of patients' safety reports, inductive content analysis of patients' suggestions to prevent the reoccurrence incidents and how those suggestions were used in healthcare organizations. RESULTS: Patients reported 656 PSIs, most of which were classified by the healthcare organizations' analysts as problems associated with information flow (32.6%) and medications (18%). Most of the incidents (65%) did not cause any harm to patients. About 76% of the reports suggested ways to prevent reoccurrence of PSIs, most of which were feasible, system-based amendments of processes for reviewing or administering treatment, anticipating risks or improving diligence in patient care. However, only 6% had led to practical implementation of corrective actions in the healthcare organizations. CONCLUSIONS: The results indicate that patients report diverse PSIs and suggest practical systems-based solutions to prevent their reoccurrence. However, patients' reports rarely lead to corrective actions documented in the registering system, indicating that there is substantial scope to improve utilization of patients' reports. There is also a need for strong patient safety management, including willingness and commitment of HCPs and leaders to learn from safety incidents.
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