Objective

Although current ethical standards mandate conflict of interest (COI) disclosure by authors of peer-reviewed publications, it is unknown whether disclosure affects a manuscript's fate. Our objective was to identify associations between author COI disclosure and editorial decision to publish.

Methods

We performed a cross-sectional observational study of editorial decisions for original research and brief research report manuscripts submitted to Annals of Emergency Medicine between June 2014 and January 2018 using data from the journal's editorial decision software and data from a prior study that characterized author COI for the same manuscripts. Outcomes of interest included final editor decision to publish (primary), initial editor decision, and number of revisions. We compared outcomes for manuscripts with COI versus those without and by type of COI (commercial/government/other).

Results

Out of 1312 manuscripts in the sample, 65.1% had no COI declarations, and 34.9% had one or more. Overall likelihood of editorial decision to publish was 13.5% (115/854) for articles without COI and 26.9% (123/458) for those with COI. Overall likelihood of editorial decision to publish was 19.8% (19/96) for articles with commercial COI only versus 33.3% (35/105) for those with government COI only.

Conclusions

Articles with author-reported COI were more likely to be published than those without such a declaration. Additionally, results suggest that reports of government COI are associated with improved chance of publication. Authorities should consider relaxing COI requirements temporarily to allow investigators to perform larger scale, randomized controlled studies of the impact of mandated COI disclosure.

BACKGROUND: Incident reporting is widely used in hospitals to improve patient safety, but current reporting systems do not function optimally. The utility of incident reports is limited because hospital staff may not know what to report, may fear retaliation, and may doubt whether administrators will review reports and respond effectively. METHODS: This is a clustered randomized controlled trial of the Safety Action Feedback and Engagement (SAFE) Loop, an intervention designed to transform hospital incident reporting systems into effective tools for improving patient safety. The SAFE Loop has six key attributes: obtaining nurses input about which safety problems to prioritize on their unit; focusing on learning about selected high-priority events; training nurses to write more informative event reports; prompting nurses to report high-priority events; integrating information about events from multiple sources; and providing feedback to nurses on findings and mitigation plans. The study will focus on medication errors and randomize 20 nursing units at a large academic/community hospital in Los Angeles. Outcomes include: (1) incident reporting practices (rates of high-priority reports, contributing factors described in reports), (2) nurses attitudes toward incident reporting, and (3) rates of high-priority events. Quantitative analyses will compare changes in outcomes pre- and post-implementation between the intervention and control nursing units, and qualitative analyses will explore nurses experiences with implementation. CONCLUSION: If effective, SAFE Loop will have several benefits: increasing nurses engagement with reporting, producing more informative reports, enabling safety leaders to understand problems, designing system-based solutions more effectively, and lowering rates of high-priority patient safety events.