Patient safety is a primary concern for EDs, and most hospitals rely on voluntary reporting of medical errors and adverse events by clinicians and nurses. However, research shows this approach can lead to an underreporting of events and errors by as much as 90%. Recently, the University of North Carolina (UNC) ED wanted to demonstrate the feasibility and usefulness of a patient-reported safety data system. The goal was to identify the extent to which patients could accurately identify safety issues.

Previously, the UNC ED used voluntary reporting by clinicians and nurses to monitor patient safety and a paper-based survey platform to measure patient experiences. However, the data from the survey platform was provided on a quarterly and then monthly basis, and there was also a low survey response rate. This led to concerns that the data received did not accurately capture the true patient experience and could have led to underreporting of adverse events.

A New Platform

Following a successful pilot test, we implemented the Bivarus platform to capture and measure patient experience and patient safety data. The platform uses a sophisticated sampling algorithm to choose a set of 10 questions out of an item bank of 50 to 100 questions that was shown in each patient’s survey. The surveys were delivered to patients via email or text message within 24 hours after a healthcare experience. Patients answer questions using a five-point scale, and free-text comments were also possible.

We analyzed patient-reported safety data over a 1-year period, and data were updated every 6 hours and available 24/7 through a web-based portal. Data were reviewed daily, and trends in quantitative and qualitative feedback helped identify opportunities for interventions and service recovery. The data could be tied to individual patient visits, which was helpful in determining interventions.

Improvements Realized

Due to the platform’s ease of use, response rates increased from 8.8% to 27.8%, giving a more accurate view of patient experiences. Over this 1-year period, the UNC ED safety team identified 242 safety-related comments within the free-text comments submitted via the Bivarus platform. The platform also offered information on other issues relating to sanitation, hand hygiene, care transitions, and medication administration. Surprisingly, only five of the 52 adverse events and near misses identified (10%) were also found in our existing adverse-event reporting system that relies on provider reports.

After implementing the Bivarus platform, we’ve improved our ability to inform and monitor interventions for patient safety. Our study illustrates that—with the right platform—engaging patients to report their own safety data can provide better actionable insights than relying solely on voluntary reporting by clinicians and nurses.