Incident Reports, Logs, and Narrative Reports Differences

Incident Reports, Logs, and Narrative Reports Differences

Introduction

The use of incidents reports, logs and narrative-only reports is commonplace in a number of public and private sectors, including law enforcement and health care where they are used to codify different types of events for different purposes. Irrespective of the setting and purpose, though, these types of written records can play a vital role in keeping track of important events and establishing accountability for future analysis or investigation. To gain some fresh insights in this area, this paper provides an explanation concerning the purposes of and differences between incident reports, logs, and narrative only reports. A discussion concerning the five rules of narrative report writing is followed by a summary of the research and important findings concerning the importance of honest, factual report writing. Review and Discussion

Incident Reports
As the term implies, an “incident report” is intended to capture the important details of an untoward incident of some type. In a tertiary health care setting, for example, incident reports may be required for all cases of patients falling (whether they injure themselves or not), for medication and blood transfusion errors, fires and instances of patient abuse (Berntsen, 2004). Unlike the continuous recording of events as with logs which are described further below, incident reports are single documents that are completed at the time of an incident and then submitted to higher authorities for analysis and action. According to Berntsen (2004), in health care settings, “Incident reports are not part of the patient record and are not shared with patients. The reports are protected from legal discovery and are generally not released outside of the hospital” (p. 44). In many cases, incident reports are carefully controlled by the quality assurance and risk management services within the medical facility (Berntsen, 2004).

It is important to trend incident reports with respect to type of incident, place of occurrence, and the responsible parties. In health care settings, for example, tracking and trending the number of medication errors may help identify a single provider who is responsible for the majority of such errors. Similarly, tracking and trends crime data by type, time and location can likewise help identify patterns that can help formulate effective law enforcement responses. For this purpose, many law enforcement agencies and health care organizations are turning to specialized incident reporting software, but the same type of results can be obtained through manual recordation (albeit with more work) as long as care is given to the accuracy of the above-mentioned details. In addition, some practitioners have used existing software tools such as Lotus Notes or Excel to develop their own customized incident reporting programs (Brenner & Freundlich, 2006). For example, one customized incident report program is based in Lotus Notes and “uses e-mail to route incident reports from direct service staff to supervisors and administrators, facilitates timely clinical oversight and risk management and ensures the security of clients’ protected health information” (Brenner & Freundlich, 2006, p. 612).

In fact, most authorities agree that computer-based tracking is the only truly effective method of tracking incident reports, particularly in larger organizations. In this regard, Berntsen (2004) reports that, “Some hospitals still use handwritten incident reports, which are labor-intensive to read and interpret. As information databases improve, hospitals will most likely improve their ability to track alarming trends. Currently, such trends may be lost amid the volume of handwritten paperwork” (p. 44). Further, compliance with national and international health care accrediting agencies frequently requires the use of automated incident reporting programs (Brenner & Freundlich, 2006) Logs

Logs consist of a series of entries in a record in a temporally linear fashion that describes all types of specified occurrences. In some cases, federal and state laws mandate the keeping of logs by some public and private sector organizations such as utility companies and defense industries (Sikura, 2002). Likewise, logs that are maintained in bound versions are traditionally known as logbooks which are commonly used in the transportation industry to record certain types of events. For instance, Black’s Law Dictionary (1990) defines a logbook as “a ship’s or aircraft’s journal containing a detailed account of the ship’s course, with a short history of every occurrence during the voyage” (p. 942). Likewise, long-haul truckers keep a logbook of when they service their vehicles, how much fuel was consumed, when and how long they stop to rest, any accidents that were experienced, and so forth.

Narrative-Only Reports

The use of narrative-only reports is also commonplace in health care settings where physicians and radiologists may dictate their diagnoses and prescribed treatment in a standard format as well as in law enforcement where these types of reports are completed in response to certain types of crimes or for specific purposes (Wells, 2003). With respect to a narrative-only report for a fraud investigation, for example, Wells (2003) points out that the report should be prepared with the potential audience in mind. In this regard, Wells advises that, “As with any written communication, the process of documenting the details of an investigation begins with an understanding of who is going to read it. A fraud report may be shared with company insiders, attorneys, defendants and witnesses, judges, juries and the media” (p. 75).

Because narrative-only reports typically concern alleged crimes or torts wherein guilt or innocence has not yet been established, it is critical that the authors of these reports limit the information to what is actually known and to avoid conjecture and opinions unless these are specifically requested as with an expert witness. For instance, Wells (2003) emphasizes that practitioners preparing narrative-only reports must “presume from the outset that many in the legal community will scrutinize whatever [they] write” and that “there is no such thing as a ‘confidential’ investigative report, no matter how it is titled” (p. 76). Just as anyone who has zapped off an email while angry can testify, written records are permanent records that must be crafted with care. In this regard, Wells cautions that, “Some people learn the hard way that if you put something in writing, you might as well carve it on Mount Rushmore–both are permanent” (2003, p. 76).

The five conventional rules of narrative report writing, capturing the “who, what, where, when and why” aspects of the event, should be supplemented with five additional standards as follows: 1. Accuracy. The report must be accurate, devoid of mistakes in dates, amounts, spelling or even in recording the most seemingly unimportant facts or details. Carelessness leaves the entire report open to question and criticism. 2. Clarity. Use clear language not subject to various interpretations. 3. Impartiality. Do not add bias or foregone conclusions. Avoid expressing opinions–let the facts speak for themselves and let others interpret them. 4. Relevance. In every investigation the investigator uncovers facts not relevant to the case; he or she should exclude such information. 5. Timeliness. Investigators should prepare reports during the course of the investigation and not long after the fact. An investigator who does not prepare a report on a timely basis runs the risk of omitting or distorting important data (Wells, 2003, p. 77). Analysis

The utility of incident reports, logs and narrative-only reports depends on how they are used. In some cases, a single incident report, log entry, or narrative-only report may be sufficient to effect meaningful change (such as a physician recommending a life-saving change in protocol as the result of a medication error or the capture of public enemy no. 1 based on the findings of a narrative-only report). In most other applications, though, these written records are only useful to the extent that they are able to provide aggregated data that can be analyzed to discern meaningful patterns. In the case of incident reports, this is a straightforward proposition. Adverse patient events are simply assigned alphanumeric codes and these data are included in a database of such incident reports to determine their frequency, location, time and other relevant information.

By very sharp contrast, log entries and narrative-only reports may contain enormously disparate data that defy the same type of coding and straightforward analysis that is provided by incident reporting programs. Nevertheless, these written records can also provide valuable clues concerning trends by identifying major themes and unexplained gaps in records (Sikora, 2002). Moreover, it is a federal crime to falsify entries on certain types of logs, making these types of analyses all the more important (Sikora, 2002).

Conclusion
Although formal incident reporting programs are a relatively recent trend, it is reasonable to conclude that ancient authorities took notice of crime trends and may have even kept track of these events for this purpose. It is known that ancient mariners kept logs of their travels, and history is replete with narrative-only reports of different types. What makes these written documents important today is their ability to provide practitioners with insights that might not be otherwise discernible if this information was considered in isolation from other relevant data.