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From incident reporting to the analysis of the patient journey

Incident reporting has been a mainstay of patient safety initiatives throughout the world, but its purpose and potential for stimulating safety improvements are still much debated. Record review studies of adverse events revealed the nature and scale of harm to patients, and it was initially hoped that incident reporting systems would capture these adverse events on an ongoing basis.1 2 This epidemiological dream was never realised; studies showed that incident reporting was actually very poor at identifying adverse events.3 Furthermore, incident reporting, record review and other systems such as pharmacy reports capture very different types of problems, which means that combining information sources can provide a more complete picture of safety issues.4 5 

In this issue, de Vos and colleagues6 extend this argument to suggest that we should draw on a number of data sources and examine the linkages between them at the patient level. Their study in Dutch hospitals examined the links between patient complaints, incident reports and adverse events. Holland has a reporting system for adverse events that is embedded in the medical record and used routinely by physicians. Incident reporting, in contrast, has evolved primarily to capture process problems (though patient accidents are still included). These arrangements differ from the UK, for instance, where incident reporting systems are still the primary means of reporting adverse events. The Dutch system allows for a much clearer separation between these data sources, which is advantageous for the study, but which limits the potential extension of its methodology to countries which do not have a means of routinely recording adverse events.

De Vos et al 6 examine a number of different relationships between incidents, adverse events and complaints. In over 26 383 admissions, 1599 (6.1%) of incidents were reported and 4838 (18.3%) adverse events were recorded. Only …