A novel approach to increase residents' involvement in reporting adverse events

David R. Scott, Melissa Weimer, Clea English, Lynn Shaker, William Ward, Dongseok Choi, Andrea Cedfeldt, Donald Girard

Research output: Contribution to journalArticlepeer-review

29 Scopus citations


PURPOSE: In the wake of the Patient Safety and Quality Improvement Act of 2005, national attention has increasingly focused on adverse-event reporting as a means of identifying systems changes to improve patient safety. However, physicians and residents have demonstrated meager involvement in this effort. METHOD: In 2008-2009, the authors measured participation in adverse-event reporting by 680 residents at Oregon Health & Science University before and after implementing a quality improvement initiative, which consisted of a financial incentive and multifaceted educational campaign. The primary measure of success was an increase in the average monthly adverse-event reports submitted by residents to greater than 5% of the institution's overall report submissions. RESULTS: The average number of adverse events reported by residents increased from 1.6% to 9.0% of the institution's overall event reports, representing a 5.6-fold increase during the initiative (P < .001). The relative percentage of resident-submitted reports defined as "near-misses" increased from 6% to 27% during the initiative (P < .001). CONCLUSIONS: The novel approach of integrating a retirement benefit and educational campaign to increase residents' involvement in adverse-event reporting was successful. In addition to increasing residents' contributions to adverse-event reporting to levels higher than any documented in the current literature, there was also a remarkable increase in the relative frequency of near-miss reporting by residents.

Original languageEnglish (US)
Pages (from-to)742-746
Number of pages5
JournalAcademic Medicine
Issue number6
StatePublished - Jun 2011

ASJC Scopus subject areas

  • Education


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