Constructing an efficient inpatient incident reporting system

Summary

The NYS Office of Mental Health invests significant staff resources in documenting, investigating, and reviewing minor incidents. This process generates an enormous amount of paperwork. A study by the NYS Commission on Quality of Care revealed that this investment, in fact, compromised the intended positive outcomes. A major flaw they cited was the requirement for identical reporting procedures for both major and minor incidents. A logging system for reporting minor incidents was developed and pilot tested in three OMH psychiatric hospitals.

The study revealed that utilization of a log system for the reporting of minor incidents greatly reduced paperwork and staff time, and that these reductions were accomplished without detriment to the quality of care. In fact, the quality of patient care may have improved. More incidents were being reported, a stable record was available on wards for clinical review, staff were enthusiastic about the log system, perhaps improving their morale, and direct care staff had more time available to spend with patients.

This type of logging system for the reporting of minor incidents would appear applicable to practically all inpatient psychiatric settings, and, if employed as intended, could be expected to contribute to an improved quality of patient care.