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September 17, 2026International Journal for Quality in Health Care

Implementing System Improvement Actions After Peer Review of Emergency Department Incident Reports: A Before-and-After Quality Improvement Evaluation

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Authors

NHNatsumi HataTNTatsuya Nishiuchi

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Overview

Before-and-after evaluation demonstrates increased incident reporting and actionable changes in an emergency department, highlighting the value of frontline peer review.

Key Points

  • To evaluate whether integrating frontline peer review and recurring joint safety meetings into an incident reporting system increases actionable system improvements and reporting frequency in an emergency department.
  • Conducted a single-center retrospective before-and-after evaluation in an urban tertiary-care emergency department comparing 12-month pre-intervention (N=29,023 visits) and post-intervention (N=28,313 visits) periods separated by a 1-month wash-in period.
  • Implemented an intervention featuring a non-punitive reporting orientation, end-of-shift discussions, monthly peer reviews by an emergency team, and monthly joint meetings with hospital safety management.
  • Measured cumulative progression milestones of system improvement actions (proposal, approval, initiation) and evaluated monthly reporting rates using interrupted time-series regression.
  • The intervention generated 24 proposed system improvements, with 20 approved and 16 initiated, including 4 requiring hospital-wide operational or policy revisions.
  • Incident report volume increased from 184 (6.34 per 1,000 visits) pre-intervention to 430 (15.19 per 1,000 visits) post-intervention.
  • Interrupted time-series regression demonstrated an immediate post-intervention increase in the reporting rate (incidence rate ratio 2.07, 95% CI 1.37 to 3.13) without a significant change in slope or shift in harm-severity distributions.

Cite This Study

Hata et al. (2026) studied this question.

synapsesocial.com/papers/6aabb8495f706d05830e7e9fhttps://doi.org/10.1093/intqhc/mzag139
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