What patient safety reporting system is used by the Veterans Health Administration?
The Veterans Health Administration (VHA) uses the Patient Safety Information System, nicknamed “SPOT.” This system was implemented and is run by the VA National Center for Patient Safety (NCPS). SPOT is an adverse event and close call reporting and analysis system that allows users to electronically document and monitors patient safety information throughout VHA. Using tools developed by NCPS, multidisciplinary teams from VHA medical facilities conduct root cause analyses of these events. Corrective actions are then planned and implemented and follow-up actions are used to determine if the corrective actions implemented were successful. A willingness and an avenue to report problems are essential to safe care because you can’t fix what you don’t know about.
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