Form #1 Form #1 Semi-structured interview guide

A

Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX

ttachment B – Semi-structured interview guide

Ask the following questions for hospitals:

1. Do you collect reports of adverse events in your hospital?

2. Who collects reports of adverse events in your hospital? Is there more than one person collecting the adverse event reports?

3. Who is able to submit an adverse event report in your hospital?

4. What is the process of adverse event reporting in your hospital?

5. What information is collected in the report?

6. Are you contracting with a Patient Safety Organization (PSO), and submitting reports to them? Why or why not?

7. Are you using the AHRQ Common Formats for reporting adverse events? Who completes these forms?

8. Did you collect adverse events prior to contracting with a PSO? If yes, what kind of adverse events were reported? For what levels of harm were adverse events reported? In what format were the adverse events reported? What are the changes in your reporting processes and occurred after contracting with a PSO for reporting purposes? What are changes in events reported and in definitions of events reported?

9. Do you collect information on adverse events that are not being reported to a PSO? Can you explain the process of collecting these adverse events? Who reports the information? How is the information collected? Are you using a standardized report form? What happens to the information? Do you maintain different reporting systems?

10. Are there other reporting systems to which you report adverse events?

11. Are you contracting with more than one PSO for reporting purposes? How many? Can you explain your process of reporting to them? Do you ever report the same event to more than one PSO?

12. Do you summarize and report adverse event information? How is the information reported and used?

13. Are reporter and patient privacy protected in your reporting system?

Ask the following questions for PSOs:

1. How many hospitals do you contract with?

2. How many hospitals are reporting adverse events to you at this point in time?

3. Do you receive adverse event reports from a limited number of event types? Which ones?

4. How much contact do you have with hospitals about the process of reporting adverse events? Can you describe your role with the hospitals vis a vis adverse event reporting?

5. How have you supported or assisted them with reporting adverse events? Can you describe the support or assistance hospitals have needed?

6. Can you describe the differences between the hospitals in their reporting processes?

Public reporting burden for this collection of information is estimated to average 60 minutes per response, the estimated time required to complete the survey. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.