Objectives: To estimate the extent, nature and consequences of adverse events in a large National Health Service (NHS) hospital, and to evaluate the reliability of a two-stage casenote review method in identifying adverse events. Design: A two-stage structured retrospective patient casenote review. Setting: A large NHS hospital in England. Population: A random sample of 1006 hospital admissions between January and May 2004: surgery (n = 311), general medicine (n = 251), elderly (n = 184), orthopaedics (n = 131), urology (n = 61) and three other specialties (n = 68). Main outcome measures: Proportion of admissions with adverse events, the proportion of preventable adverse events, and the types and consequences of adverse events. Results: 8.7% (n = 87) of the 1006 admissions had at least one adverse event (95% CI 7.0% to 10.4%), of which 31% (n = 27) were preventable. 15% of adverse events led to impairment or disability which lasted more than 6 months and another 10% contributed to patient death. Adverse events led to a mean increased length of stay of 8 days (95% CI 6.5 to 9). The sensitivity of the screening criteria in identifying adverse events was 92% (95% CI 87% to 96%) and the specificity was 62% (95% CI 53% to 71%). Inter-rater reliability for determination of adverse events was good (k = 0.64), but for the assessment of preventability it was only moderate (k = 0.44). Conclusion: This study confirms that adverse events are common, serious and potentially preventable source of harm to patients in NHS hospitals. The accuracy and reliability of a structured two-stage casenote review in identifying adverse events in the UK was confirmed. S tudies across the world have shown that between 3% and 17% of hospital admissions result in an adverse event (defined as any unintended event caused at least partly by healthcare and which resulted in harm), and that between 28 and 75 percent of them are preventable.

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This article reports the results of a study into the use of personal professional profiles by nurses, midwives and health visitors in an NHS trust. The author discusses factors in profile development, compares profile use between grades and attempts to identify the need for in-service education and support for profile development.

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The transition between ST2 and ST3 in O&G is a challenging and daunting time. Following the introduction of MMC and the EWTD, clinical experience prior to commencing second on call responsibilities has reduced. Furthermore, statements such as ‘mothers face more risk at night because trainee obstetricians tend to be less experienced’ and ‘junior obstetric doctors could lack the technical skills and experience needed to help make the birth process easier’1 are concerning to all. In August 2010, when the first complete cohort of specialty trainees was approaching the end of ST3, a survey was distributed to senior SHOs and junior Registrars in Severn, Wessex and Peninsula deaneries to assess trainees' self-perceived readiness to proceed to ST3. Data collected included training experience; confidence and competence levels; number of essential procedures performed with and without supervision and experience of obstetric emergencies. Trainees were also asked whether anything was/could be done in order to prepare them more for their new role. Although all trainees had at least 2 years experience, 44% were ‘not very confident’ or ‘terrified’ about commencing ST3. Trainees generally felt ‘reasonably competent’ despite having performed minimal numbers of essential procedures without supervision and having nominal experience of obstetric emergencies. Most trainees felt that despite this they did not require more time as an SHO but would appreciate a more formal period of ‘acting up’. This information can now be fed back to training programme directors to action in attempts to ease and improve the transition period and ultimately patient safety.