Using Patient Safety Reporting Systems to Understand the Clinical Learning Environment: A Content Analysis.

Objective: To examine patient safety event reporting behavior by trainees caring for surgical patients compared to other clinicians.

Design: Qualitative analysis of a patient safety event reporting system comparing reports entered by trainees to those entered by attending physicians and nurses. Categorical data associated with reports were compared, and free-text event descriptions underwent content analysis focusing on themes related to report completeness and report focus.

Setting: The Hospital of the University of Pennsylvania, an academic tertiary care hospital in Philadelphia, Pennsylvania.

Participants: All patient safety event reports related to surgical patients from a 6-month period (July-December 2016).

Results: One thousand four hundred twenty-three reports were entered by trainees (T), attendings (A), and nurses (N). Trainees had a lower number of reports entered per reporter compared to nurses (T median [IQR]: 1 [1-2], N: 2 [1-3]), and the highest percentage of reports entered anonymously for any group (T: 28.7%, N: 9.9%, A: 4.6%). The overall distribution of event location and event type differed significantly between groups (p < 0.001). Trainee reports were found to have a broader range of focus, more elements associated with completeness of reports, and more frequent use of blame language.

Conclusions: Surgical trainees report a wide variety of issues in the perioperative, floor, and ICU settings. Their reports often include more details than those entered by other clinicians, but feature higher rates of anonymous reporting and use of blame language. Analysis of patient safety event reports by trainees compared with other healthcare professionals can reveal important insights into the clinical learning environment and areas for safety improvement.