Use of a residency program incident reporting system as an educational tool

Residency programs can take advantage of institution-wide incident reporting systems to develop their own systems to improve program management and enhance education in communication, conflict resolution, and malpractice prevention. Our internal medicine residency program developed a secure, computerized log to track all incident reports from reception to final resolution. Data on source, subject matter, and method of resolution of each incident report were tallied. From January 1, 1992 through December 31, 1995, 33 incident reports were received, for an incidence of 0.43 (95% confidence interval: 0.25, 0.61) per resident per year. About half occurred in the hospital and half in the outpatient setting. Over two-thirds were generated by the clinic-wide incident reporting system and over one-half involved patient expression of dissatisfaction with care. After the program director spoke with all involved parties, nearly two-thirds were resolved by the resident writing a letter to legal services, the patient, or the hospital quality assurance program. A resident incident reporting system is an important management tool that can enhance the curriculum of the program, identify resident or faculty stressors, and correct ineffectual institutional or program policies. The estimate of about one incident report per two residents per year is probably high based on the threshold for reporting incidents at our institution. Though our program judges that the benefits of such a program outweigh the burdens, other studies are needed.