An investigation of barriers to reporting anaesthesia-related critical incidents using the National Guideline for Patient Safety Incident Reporting and Learning

Abstract

Background: Learning from anaesthesia-related critical incidents (ARCI) is essential to improving patient safety and outcomes in the perioperative period. Locally, the Department of Health’s National Guideline for Patient Safety Incident Reporting and Learning (NPSIRL) mandates the disclosure of all patient safety incidents (PSI). However, under-reporting is a major issue. This study investigates the determinants of poor guideline adherence within anaesthetic practice by identifying barriers specific to the NPSIRL process and quantifying their impact on ARCI disclosure.

Methods: A self-administered online questionnaire was distributed to all doctors working in anaesthesia at university-affiliated training hospitals in KwaZulu-Natal. In addition to demographic and professional data, barriers to incident reporting were identified through thematically grouped open-ended questions and responses to 24 previously recognised barrier statements.

Results: The analysis included 122 complete responses from anaesthetists at 17 institutions. Of the participants, 34% had never reported a PSI using the NPSIRL system, with 75% having reported two or fewer ARCIs in the preceding 12 months. Fear of adverse consequences was the most common self-reported barrier theme (58%), followed by system-related reporting factors (49%). Of the previously identified barrier statements, a lack of feedback (86%), the reporting process being too time-consuming (70%), concerns about being blamed or disciplinary action (69%), and a lack of training (68%) were most frequently cited. Subgroup analysis showed that a lack of training and the time required to complete a report was more commonly associated with less experienced and junior anaesthetists.

Conclusion: Under-reporting of ARCIs, a consequence of the barriers identified in this study, represents a missed learning opportunity to ensure patient safety-orientated care. Strategies aimed at improving the reporting of ARCIs in South Africa require careful consideration of the context-specific challenges and barriers identified in this study.