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ORIGINAL ARTICLE |
1 Field Office of VA’s National Center for Patient Safety, White River Junction, VT; Veterans Health Administration; The Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, NH, USA
2 VA National Quality Scholars Fellowship Program; Field Office of VA’s National Center for Patient Safety; Director, Veterans Rural Health Initiative, White River Junction, VT; Veterans Health Administration; Departments of Psychiatry and of Community and Family Medicine, Dartmouth Medical School, Hanover, NH, USA
Correspondence to:
MrJ M Schmidek
VAMC (11Q), 215 Main Street, White River Junction, VT 05009, USA; jared.schmidek{at}dartmouth.edu
Objective: The Veterans Health Administration’s patient incident reporting system was established to obtain comprehensive data on adverse events that affect patients and to act as a harbinger for risk management. It maintains a dataset of tort claims that are made against Veterans Administration’s employees acting within the scope of employment. In an effort to understand the thoroughness of reporting, we examined the relationship between tort claims and patient incident reports (PIRs).
Methods: Using social security and record numbers, we matched 8260 tort claims and 32 207 PIRs from fiscal years 1993–2000. Tort claims and PIRs were considered to be related if the recorded dates of incident were within 1 month of each other. Descriptive statistics, odds ratios, and two sample t tests with unequal variances were used to determine the relationship between PIRs and tort claims.
Results: 4.15% of claims had a related PIR. Claim payment (either settlement or judgment for plaintiff) was more likely when associated with a PIR (OR 3.62; 95% CI 2.87 to 4.60). Payment was most likely for medication errors (OR 8.37; 95% CI 2.05 to 73.25) and least likely for suicides (OR 0.25; 95% CI 0.11 to 0.55).
Conclusions: Although few tort claims had a related PIR, if a PIR was present the tort claim was more likely to result in a payment; moreover, the payment was likely to be higher. Underreporting of patient incidents that developed into tort claims was evident. Our findings suggest that, in the Veterans Health Administration, there is a higher propensity to both report and settle PIRs with bad outcomes.
Keywords: incident reporting; tort claims; Veterans Health Administration
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