PatSIS

PatSIS is an incident reporting system used in hospitals. It was developed to systemise the reporting and monitoring of adverse events and near misses, so as to contribute to a high level of risk awareness in healthcare facilities and lead to pro-active system changes to decrease the probability of errors.

The programme is a multidisciplinary solution to adverse events and an alternative to the time-consuming, paper-based process that is currently used in many healthcare facilities. An incident reporting, monitoring and management system is primarily used for patient safety.

The importance of Patient Safety

Thousands of errors occur in healthcare systems around every single day. Patient safety has therefore become an issue of immense importance, in both first and third world contexts.

About 50% of healthcare errors are considered preventable and with an estimated average of 10% of all in-patient visits resulting in some form of unintended harm, the need to tackle patient safety is clear.1

Patient safety is not only challenged by the complexity of care processes, but also by a culture of denial and blame, and by an inconsistent reporting and learning system that has prevented the collection and dissemination of information in a meaningful way.

This is why hospital incident reporting is so important.

Transition from AIMS to PatSIS

In 2008, the Australian Advanced Incident Management System (AIMS) was implemented in 24 facilities in the Free State Province. The programme demonstrated tangible benefits and additional facilities were enrolled over time.

In 2012, the system was entered into the Centre for Public Service Innovation Awards, where it achieved second runner-up position.

However, AIMS was discontinued in 2013. COHSASA developed PatSIS to replace AIMS. The new programme, a hospital incident reporting system, was designed specifically for conditions in developing countries.

PatSIS is a medical incident management system that consists of two parts: A computer programme that records information about adverse events and near misses, and a call centre operated by professional healthcare staff to collect data on incidents.

Some of the benefits of PatSIS include: Reduced litigation, improved patient safety and quality of care, increased patient satisfaction, reduced number of complaints, staff morale boost.

PatSIS works as follows:

  • Information regarding an incident is gathered by means of incident-specific cascading questions.
  • Once all information is entered, an email notification is sent to relevant staff members to initiate an investigation into the incident report.
  • When a serious adverse event (e.g. death) is reported, nominated senior staff and management at the facility are alerted by means of email and SMS.
  • Email reminders are sent at pre-determined intervals until an investigation is completed and recorded in PatSIS, along with the preventive measures planned to prevent recurrence.
  • These entries are reviewed by PatSIS staff trained in adverse event management.
  • Any inadequacies in investigation or response are reported to facility staff and guidance given on additional actions required to prevent recurrence.
  • Recorded data is then available for analysis at individual facility level or across facilities in a region or province.

Healthcare today is a complex mater. Patient outcomes depend on much more than just the competence of an individual health care provider. Therefore, for a system like PatSIS to work, the focus is on the investigation and reporting of incidents, rather than apportioning blame to individuals. Participation in the process for the benefit of future service delivery is encouraged, rather than avoidance of the process due to fear of retribution.

Through PatSIS, lessons are learnt that will inform the design and implementation of processes to reduce the likelihood of recurrence of the medical incident and minimise harm should the incident recur.

Further reading:

For more information on PatSIS, please download the brochure here.

To view articles associated with Patient Safety, please click here.

Before the development and implementation of PatSIS, the AIMS system was used. For more information about this, read here.

1 Information from Technical Paper - Regional Strategy for Enhancing Patient Safety (Regional Committee for the Eastern Mediterranean Region) September 2005, World Health Organisation.