Hospital patient safety culture and beyond: Incident reporting trends in an Italian academic hospital

Background Incident Reporting (IR) is one of the most widely accepted tools for identifying and analyzing healthcare related risks; it is directly related with improvement of patient safety culture in healthcare workers. According to literature, doctors are known for being less committed to IR than nurses. Objects and Methods The aim of the study was to analyze professionals attitude to report and potential reporting trends during years 2010-15, comparing them to other more general risk indicators supported by existing routine databases, such as patients complaints/praises and professionals accidents at work. Reporting rates, stratified by year and reporter profession, were estimated using the reported events/full time equivalent ratio. Personnel attitude toward self-reporting was also analyzed. Univariate and multivariate analysis were computed. Results A total of 8809 IRs were collected, corresponding to 1 every 77.7 discharges; reporting rates were 0.44 (95% CI: 0.42-0.46) for doctors, 0.40 (95% CI: 0.39-0.41) for nurses and 0.17 (95% CI: 0.16-0.18) for other professionals. Among professionals, only doctors reporting rate increased significantly (p=0.04) from 0.29 (95%CI: 0.25-0.34) in 2010 to 0.67 (95%CI: 0.60-0.73) in 2015. In the same period, patients complaints decreased from 384 to 224 (p<0.001), while praises increased from 199 to 232 (p=0.04) and workaccidents remained constant. Multivariate logistic regression showed that self-reporting was more likely among nurses than doctors (OR 1.51; 95%CI 1.31-1.73) and for severe events than near misses (OR 1.78; 95%CI 1.11-2.87). Conclusions Contrary to previous literature, in our study doctors seemed to be more prone to report adverse events than nurses although nurses showed higher proportions of self-reported events. Doctor reporting rates increased significantly during the study period; as the other analyzed risk indicators suggest, this trend was probably due to personnel growing attention to patient safety issues.