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Barriers to incident notification in a regional prehospital setting
  1. P A Jennings1,2,
  2. J Stella3,4
  1. 1Monash University, Department of Epidemiology and Preventive Medicine, Melbourne, Victoria, Australia
  2. 2Ambulance Victoria, Geelong, Victoria, Australia
  3. 3Emergency Department, The Geelong Hospital, Geelong, Victoria, Australia
  4. 4Clinical School of St Vincent's and Geelong Hospital, Geelong, Victoria, Australia
  1. Correspondence to Paul Andrew Jennings, Ambulance Victoria, Locked Bag 9000, Ballarat Mail Centre, Victoria 3354, Australia; paul.jennings{at}ambulance.vic.gov.au

Abstract

Background The identification and monitoring of critical incidents or adverse events and error reporting is a relatively new area of study in the prehospital setting. In 2005, we commenced a prospective descriptive study of the implementation of a Critical Incident Monitoring process in a rural/regional pre-hospital setting. The objective of the project was to describe the nature and incidence of errors detected in the management of prehospital trauma with the ultimate aim of identifying processes to reduce or mitigate such incidents. This paper describes the barriers to reporting critical incidents identified during the 3-year study.

Method This study used a qualitative approach involving the triangulation of a number of ethnographic methodologies, including unscripted focus groups, informal interviews and qualitative aspects of surveys utilised in a broader research project. Prevailing themes were fed back to participants in an iterative process to further explore perceptions and beliefs regarding these concepts. The final analysis of themes is descriptively presented.

Results A number of barriers were identified and categorised into seven themes. These themes were; Burden of reporting, fear of disciplinary action, fear of potential litigation, fear of breaches of confidentiality and fear of embarrassment, concern that ‘nothing would change’ even if the incident was reported, lack of familiarity with process and impact of ‘blame culture’.

Conclusion There are numerous barriers to reporting critical incidents. One of the key approaches which may alleviate many of the barriers to reporting is shifting to a systems based focus rather than an individual ‘shame and blame’ approach. The underlying barriers lie in the culture of the profession, and appear consistent across other health care disciplines.

  • Emergency medical services
  • risk management
  • medical errors
  • safety management
  • communication barriers
  • emergency ambulance systems
  • management
  • quality assurance
  • nursing
  • pre-hospital

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Footnotes

  • Funding Transport Accident Commission 60 Brougham Street, Geelong Victoria Australia 3220.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Barwon Health HREC.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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