Accession Number:

ADA434331

Title:

Implementation of a Data-Based Medical Event Reporting System in the U.S. Department of Defense

Descriptive Note:

Corporate Author:

AGENCY FOR HEALTHCARE RESEARCH AND QUALITY ROCKVILLE MD

Personal Author(s):

Report Date:

2005-05-01

Pagination or Media Count:

11.0

Abstract:

As a result of the Institute of Medicine IOM report, To Err Is Human, the Department of Defense DoD, per the direction of President Clinton, developed an action plan to reduce medical errors. A system to track and trend near misses and adverse safety events for all the medical treatment facilities in the DoD was developed. A standard spreadsheet for data collection through e-mail was created and implemented. A relational database management system was utilized for data analysis. The data reporting system is a qualified success. There are limitations with statistical analysis and variations in the data submitted. The system has helped to identify patterns of patient safety errors and areas where patient safety events warrant further investigation.

Subject Categories:

  • Information Science
  • Computer Programming and Software
  • Medical Facilities, Equipment and Supplies
  • Logistics, Military Facilities and Supplies

Distribution Statement:

APPROVED FOR PUBLIC RELEASE