Incident Reports, Logs, and Narrative Report Writing Rules

Introduction

The use of incident 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, these types of written records can play a vital role in keeping track of important events and establishing accountability for future analysis or investigation. This paper provides an explanation of the purposes of and differences among incident reports, logs, and narrative-only reports. A discussion of the five rules of narrative report writing is followed by a summary of important findings concerning the value of honest, factual documentation.

Incident Reports

As the term implies, an "incident report" is intended to capture the important details of an untoward event 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 found in logs, incident reports are single documents 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 crime data by type, time, and location can help identify patterns that inform effective law enforcement responses. For this purpose, many law enforcement agencies and health care organizations are turning to specialized incident reporting software, though the same results can be obtained through manual recordation — albeit with more effort — as long as care is given to the accuracy of the details noted above. Some practitioners have also used existing software tools such as Lotus Notes or Excel to develop their own customized incident reporting programs (Brenner & Freundlich, 2006). One such customized program based in Lotus Notes "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).

Most authorities agree that computer-based tracking is the only truly effective method of managing incident reports, particularly in larger organizations. 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). Furthermore, 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 recorded in a temporally linear fashion that describes all specified occurrences of a given type. In some cases, federal and state laws mandate the keeping of logs by certain public and private sector organizations, such as utility companies and defense industries (Sikura, 2002). Logs maintained in bound form are traditionally known as logbooks, which are commonly used in the transportation industry to record certain types of events. 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). Similarly, long-haul truckers keep a logbook of vehicle servicing, fuel consumption, rest stops, any accidents experienced, and so forth.

Narrative-Only Reports and the Five Rules of Report Writing

The use of narrative-only reports is commonplace in health care settings, where physicians and radiologists may dictate their diagnoses and prescribed treatments in a standard format, as well as in law enforcement, where these reports are completed in response to certain crimes or for specific purposes (Wells, 2003). With respect to a narrative-only report for a fraud investigation, Wells (2003) points out that the report should be prepared with the potential audience in mind: "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 in which guilt or innocence has not yet been established, it is critical that authors limit the information to what is actually known and avoid conjecture and opinions unless these are specifically requested, as with an expert witness. 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). Written records are permanent records that must be crafted with care. As Wells cautions, "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 capture the "who, what, where, when, and why" of an event. These should be supplemented with five additional standards:

1. Accuracy. The report must be accurate, devoid of mistakes in dates, amounts, spelling, or even seemingly unimportant facts or details. Carelessness leaves the entire report open to question and criticism.
2. Clarity. Use clear language that is not subject to varying interpretations.
3. Impartiality. Do not introduce bias or foregone conclusions. Avoid expressing opinions — let the facts speak for themselves and allow others to interpret them.
4. Relevance. In every investigation, investigators uncover facts not relevant to the case; such information should be excluded from the report.
5. Timeliness. Investigators should prepare reports during the course of the investigation, not long after the fact. An investigator who does not prepare a report on a timely basis risks omitting or distorting important data (Wells, 2003, p. 77).

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 kept track of such events for this purpose. It is known that ancient mariners kept logs of their travels, and history is replete with narrative-only reports of many kinds. What makes these written documents important today is their ability to provide practitioners with insights that might not otherwise be discernible if information were considered in isolation from other relevant data.

References

Berntsen, K. J. (2004). The patient's guide to preventing medical errors. Praeger.

Black's law dictionary. (1990). West Publishing Co.

Brenner, E., & Freundlich, M. (2006, May/June). Enhancing the safety of children in foster care and family support programs: Automated critical incident reporting. Child Welfare, 85(3), 611–619.

Sikura, V. A. (2002, May). Water, water, everywhere. Journal of Environmental Health, 64(9), 37–41.

Wells, J. T. (2003, December). Rules for the written record: Fraud reports are quite different from audit reports. Journal of Accountancy, 196(6), 75–79.