Objectives: To assess awareness and use of the current incident reporting system and to identify factors inhibiting reporting of incidents in hospitals. Design, setting and participants: Anonymous survey of 186 doctors and 587 nurses from diverse clinical settings in six South Australian hospitals (response rate = 70.7% and 73.6%, respectively). Main outcome measures: Knowledge and use of the current reporting system; barriers to incident reporting. Results: Most doctors and nurses (98.3%) were aware that their hospital had an incident reporting system. Nurses were more likely than doctors to know how to access a report (88.3% v 43.0%; relative risk (RR) 2.05, 95% CI 1.61 to 2.63), to have ever completed a report (89.2% v 64.4%; RR 1.38, 95% CI 1.19 to 1.61), and to know what to do with the completed report (81.9% v 49.7%; RR 1.65, 95% CI 1.27 to 2.13). Staff were more likely to report incidents which are habitually reported, often witnessed, and usually associated with immediate outcomes such as patient falls and medication errors requiring corrective treatment. Near misses and incidents which occur over time such as pressure ulcers and DVT due to inadequate prophylaxis were least likely to be reported. The most frequently stated barrier to reporting for doctors and nurses was lack of feedback (57.7% and 61.8% agreeing, respectively). Conclusions: Both doctors and nurses believe they should report most incidents, but nurses do so more frequently than doctors. To improve incident reporting, especially among doctors, clarification is needed of which incidents should be reported, the process needs to be simplified, and feedback given to reporters.I t is a decade since Leape 1 highlighted the need to gather information and redesign hospital systems to minimise errors in health care. Since then, many strategies and tools have been developed to identify and reduce errors. 2 More than 90% of consumers believe that healthcare workers should report errors, 3 and peak quality and safety organisations 4-6 recommend incident reporting to better understand errors and their contributing factors.Incidents occurring infrequently, or those not easily coded through limitations in the existing classification system, 7 can miss detection through medical record review. Incident reporting captures more contextual information about incidents 8 and, when actively promoted within the clinical setting, it can detect more preventable adverse events than medical record review 9 at a fraction of the cost. 10 Near misses are rarely documented in medical records, 11 yet occur more frequently than adverse events 12 and provide valuable lessons in recovery mechanisms without the detrimental consequences of an adverse event. 5 6 The subjective data provided by incident reporting enable hypothesis building and preventative strategies to be developed and tested.Despite its strengths, many incidents are not reported probably for the same reasons they are omitted from medical records; they are simply not recognised, and those that are detected afte...

Objectives: (i) To examine attitudes of medical and nursing staff towards reporting incidents (adverse events and near‐misses), and (ii) to identify measures to facilitate incident reporting. Design: Qualitative study. In March 2002, semistructured questions were administered to five focus groups — one each for consultants, registrars, resident medical officers, senior nurses, and junior nurses. Participants and setting: 14 medical and 19 nursing staff recruited using purposive sampling from three metropolitan public hospitals in Adelaide, South Australia. Main outcome measures: Attitudes and barriers to incident reporting; differences in reporting behaviour between disciplines; how to facilitate incident reporting. Results: Cultural differences between doctors and nurses, identified using Triandis’ theory of social behaviour, were found to underpin attitudes to incident reporting. Nurses reported more habitually than doctors due to a culture which provided directives, protocols and the notion of security, whereas the medical culture was less transparent, favoured dealing with incidents “in‐house” and was less reliant on directives. Common barriers to reporting incidents included time constraints, unsatisfactory processes, deficiencies in knowledge, cultural norms, inadequate feedback, beliefs about risk, and a perceived lack of value in the process. Conclusions: Strategies to improve incident reporting must address cultural issues.

Cerebral palsy (CP), a neurodevelopmental disorder characterized by irreversible, nonprogressive central motor dysfunction, is commonly associated with prematurity or perinatal brain injury. However, accumulating evidence suggests deleterious genomic variants may contribute to CP in addition to environmental insults. To identify genes contributing to risk for CP, we performed whole-exome sequencing on 250 parent-offspring CP trios. We identified a significant contribution of damaging de novo mutations (DNMs), especially in genes that are intolerant to loss of function mutations. Eight genes had multiple, independently-arising damaging DNMs, including two novel CP-associated genes, FBXO31 and RHOB, and four genes previously implicated in cerebral palsy phenotypes, TUBA1A, CTNNB1, SPAST, and ATL1. Functional experiments, including molecular and biochemical assays and patient fibroblast studies indicate that the recurrent RHOB mutation identified in patients enhances Rho effector binding in the active state and that the FBXO31 mutation leads to elevated levels of cyclin D. Analysis of candidate CP risk genes highlighted genetic overlap with hereditary spastic paraplegia as well as intellectual disability, autism, and epilepsy, converging with epidemiologic findings. Computational network analysis of risk genes identified significant enrichment of Rho GTPase, extracellular matrix, focal adhesions, cytoskeleton, and cell projection pathways. CP risk genes in Rho GTPase, cytoskeleton and cell projection pathways were found to play an important role in neuromotor development via a Drosophila reverse genetics screen. Based on enrichment analysis, we estimate that an excess of damaging de novo and inherited recessive variants collectively account for ~14% of the cases in our cohort, whereas perinatal asphyxia is currently estimated to occur in 8-10% of CP cases. Together, these findings provide evidence for the role of genetically-mediated dysregulation of early brain connectivity in CP.

BackgroundThe Vaccine Assessment using Linked Data (VALiD) trial compared opt-in and opt-out parental consent for a population-based childhood vaccine safety surveillance program using data linkage. A subsequent telephone interview of all households enrolled in the trial elicited parental intent regarding the return or non-return of reply forms for opt-in and opt-out consent. This paper describes the rationale for the trial and provides an overview of the design and methods.Methods/DesignSingle-centre, single-blind, randomised controlled trial (RCT) stratified by firstborn status. Mothers who gave birth at one tertiary South Australian hospital were randomised at six weeks post-partum to receive an opt-in or opt-out reply form, along with information explaining data linkage. The primary outcome at 10 weeks post-partum was parental participation in each arm, as indicated by the respective return or non-return of a reply form (or via telephone or email response). A subsequent telephone interview at 10 weeks post-partum elicited parental intent regarding the return or non-return of the reply form, and attitudes and knowledge about data linkage, vaccine safety, consent preferences and vaccination practices. Enrolment began in July 2009 and 1,129 households were recruited in a three-month period. Analysis has not yet been undertaken. The participation rate and selection bias for each method of consent will be compared when the data are analysed.DiscussionThe VALiD RCT represents the first trial of opt-in versus opt-out consent for a data linkage study that assesses consent preferences and intent compared with actual opting in or opting out behaviour, and socioeconomic factors. The limitations to generalisability are discussed.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12610000332022

The relationship between workers' alcohol consumption patterns and absenteeism is more substantial than previously recognized or documented. Alcohol-related absenteeism is not restricted to small numbers of chronic heavy drinkers, but also involves the much larger number of risky non-dependent drinkers who drink less frequently at risky levels. To improve workers' health and wellbeing and enhance productivity and economic prosperity, appropriate education, prevention and policy strategies are warranted and necessitate revision of previously narrow approaches undertaken with work-place programmes.