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Incident Reporting in Emergency Medicine: A Thematic Analysis of Events

Aaronson, Emily Loving MD*†; Brown, David MD*; Benzer, Theodore MD, PhD*; Natsui, Shaw MD*‡; Mort, Elizabeth MD, MPH†§

doi: 10.1097/PTS.0000000000000399
Original Article: PDF Only

Background Incident reporting is a recognized tool for healthcare quality improvement. These systems, which aim to capture near-misses and harm events, enable organizations to gather critical information about failure modes and design mitigation strategies. Although many hospitals have employed these systems, little is known about safety themes in emergency medicine incident reporting. Our objective was to systematically analyze and thematically code 1 year of incident reports.

Methods A mixed-methods analysis was performed on 1 year of safety reporting data from a large, urban tertiary-care emergency department using a modified grounded theory approach.

Results Between January 1 and December 31, 2015, there were 108,436 emergency department visits. During this time, 750 incident reports were filed. Twenty-nine themes were used to code the reports, with 744 codes applied. The most common themes were related to delays (138/750, 18.4%), medication safety (136/750, 18.1%), and failures in communication (110/750, 14.7%). A total of 48.8% (366/750) of reports were submitted by nurses.

Conclusions The most prominent themes during 1 year of incident reports were related to medication safety, delays, and communication. Relative to hospital-wide reporting patterns, a higher proportion of reports were submitted by physicians. Despite this, overall incident reporting remains low, and more is needed to engage physicians in reporting.

From the *Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School; †Lawrence Center for Quality and Safety, Massachusetts General Hospital and Massachusetts General Physicians' Organization; ‡Harvard Affiliated Emergency Medicine Residency Program, and §Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Correspondence: Emily Aaronson, MD, Department of Emergency Medicine, Harvard Affiliated Emergency Medicine Residency, 0 Emerson Place, Suite 3B Boston, MA 02115 (e-mail:

The authors disclose no conflict of interest.

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