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Critical incidence reporting in dermatology: a cross-sectional study of 94 cases in a tertiary referral center

INTRODUCTION
Over the past 15 years, most health care institutions in developed countries have established a critical incident reporting system (CIRS) to prevent future critical incidents. While in various specialties cases filed in such systems have been analyzed and published, no publications on CIRS cases in dermatology are available so far, although this specialty has been reported to be at increased risk for malpractice.


MATERIAL AND METHODS
All dermatology-related cases filed in the CIRS of our tertiary referral center between 2012-2019 were analysed.


RESULTS
The vast majority of the 94 filed cases were reported by nursing staff, less than 10% by dermatologists. Consequences of variable severity resulted, in 40.9% they were categorized as "severe", in 1.5% as "catastrophic". The likelihood of reoccurrence was rated "possible" in 60.6% and "likely" in 33.3%. The top-five contributing factors were medication errors (20.7%), personal factors (19.7%), communication errors (17.8%), lack of training& knowledge (13.5%) and organizational reasons (10.6%).


DISCUSSION
Critical incidents in dermatological clinical routine are potentially severe, they most commonly involve medication errors, personal factors and communication errors. More than a third of all cases resulted in a potentially severe consequence, with the likelihood of reoccurrence of >90%.