Eight-year longitudinal evaluation of an electronic patient safety reporting system in a public hospital

PURPOSE: This paper aims to evaluate changes in reporting rates and notification timeliness following implementation of an electronic patient safety reporting system in a high-complexity public hospital over eight years. DESIGN/METHODOLOGY/APPROACH: A quasi-experimental before-after study without a control group analysed all eligible inpatient reports recorded from 2015 to 2022. The pre-implementation period was compared with the post-implementation period. Rates were calculated per 100 discharges and timeliness as notification days. A post hoc temporal sensitivity analysis compared pre-implementation, 2019 (pre-pandemic), 2020-2021 (early pandemic), and 2022 using Poisson rate ratios. FINDINGS: Among 14,017 reports, the rate increased from 3.47 to 13.37 per 100 discharges (RR 3.86, 95% CI 3.70-4.02). It had already reached 7.58 in 2019 (rate ratio 2.19, 95% confidence interval 2.06-2.32 versus pre-implementation), rose to 15.30 during 2020-2021, and remained 15.86 in 2022. Median notification time decreased from 9 to 1 day. The change therefore began before Coronavirus Disease 2019 (COVID-19) and persisted in 2022. The electronic system may have contributed, particularly to notification timeliness, but the design does not support causal attribution. ORIGINALITY/VALUE: Separating temporal phases shows that the increase preceded COVID-19 and persisted in 2022. The findings are consistent with a possible contribution from electronic implementation, particularly to notification timeliness, while acknowledging that pandemic-related changes, increased safety awareness and previous underreporting may also have influenced reporting volume.