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Defense Health Agency Should Improve Tracking of Serious Adverse Medical Events and Monitoring of Required Follow-up.

Washington, DC: United States Government Accountability Office; April 2018. Publication GAO-18-378.

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May 16, 2018
Washington, DC: United States Government Accountability Office; April 2018. Publication GAO-18-378.

Adverse event reporting is an important step toward failure reduction. However, weaknesses in feedback, follow-up, and action resulting from incident reports diminish their impact on safety. This publication analyzed reporting activity and action in the Defense Health Agency. The resulting recommendations suggest the need to improve tracking of incident reports and for clarifying reporting requirements.

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Washington, DC: United States Government Accountability Office; April 2018. Publication GAO-18-378.

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