Abstract
We congratulate Ernesäter et al. on their study of incident reporting in nurse-led telephone triage in Sweden. 1 The reporting of errors is crucial to the process of error management. 2 If adverse incidents are to be minimised, organisations must learn from their mistakes. 3 We were very impressed by the low rate of adverse errors or near misses reported by Ernesäter et al.: one in 761 telephone calls. Such a low rate of errors could suggest either a successful and safe organizational practice, or a lack of culture of security. 4 Many studies have shown that in health care, errors are frequent. 5 For example, Donchin et al. found that the average patient experiences 1.7 errors per day in intensive care units. 6 Hence, we totally agree with the authors when they suggest that such a rate is likely to be associated with under-reporting.
Under-reporting is a significant problem in heath systems. Based on the experience of nurses, Barach and Small assessed that under-reporting of adverse events in the USA is 50–96% annually. 7 Fundamentally, however, the actual reporting of adverse errors or near misses is a process that is often ignored in health-care institutions. Ernesäter et al. hypothesized that under-reporting was due to a ‘shame and blame’ culture, an inherently punitive approach that inhibits error reporting.
We want to go further in this debate and emphasize that the Achilles' heel of many error-reporting systems is an uneasy paper-based declaration process, and highlight an approach which may alleviate many of the barriers to reporting, which is a shift to web-based systems. From an information technology perspective, the reporting of medical errors should be designed to be as simple and easy-to-use as possible. Thus the development and implementation of electronic systems is an obvious key to success. 8 It is imperative to use the best available technologies to report, collect and analyse medical errors and near misses. Leaders should be aware of the web-based systems that make access simpler for staff anywhere in an organization. These systems are a much more powerful substitute for the PC-based software that was used in the past. For example, web-based systems allow for absolute anonymity while reporting, online education and secure hosting of the data. They also permit people to participate in regional benchmarking studies and learn from each other by contributing selected pieces of data into larger national databases effortlessly. 9,10
Another advantage of web-based systems is the immediate impact of the data. Participants have a tool in which they can declare errors at any time of the day. Web-based reporting systems allow selected leaders to have access to cumulative data, and to analyse data in the database. They get an almost instantaneous picture of the experience within the health system, what the follow-up is, and how to address and resolve questions of interest.
The implementation and expansion of a web-based reporting system can make participants' lives easier, increase the rate of error reporting and increase the time spent on solving problems instead of describing them. These may all lead to improved quality and security of patient care. 10