Trends in healthcare incident reporting and relationship to safety and quality data in acute hospitals: results from the National Reporting and Learning System

Abstract

Background: Internationally, there is increasing recognition of the need to collect and analyse data on patient safety incidents, to facilitate learning and develop solutions. The National Patient Safety Agency (NPSA) for England and Wales has been capturing incident data from acute hospitals since November 2003. Objectives: This study analyses patterns in reporting of patient safety incidents from all acute hospitals in England to the NPSA National Reporting and Learning System, and explores the link between reporting rates, hospital characteristics, and other safety and quality datasets. Methods: Reporting rates to the NPSA National Reporting and Learning System were analysed as trends over time, from the point at which each hospital became connected to the system. The relationships between reporting rates and other safety and quality datasets were assessed using correlation and regression analyses. Results: Reporting rates increased steadily over the 18 months analysed. Higher reporting rates correlated with positive data on safety culture and incident reporting from the NHS Staff Survey, and with better riskmanagement ratings from the NHS Litigation Authority. Hospitals with higher overall reporting rates had a lower proportion of their reports in the ''slips, trips and falls'' category, suggesting that these hospitals were reporting higher numbers of other types of incident. There was no apparent association between reporting rates and the following data: standardised mortality ratios, data from other safety-related reporting systems, hospital size, average patient age or length of stay. Conclusions: Incident reporting rates from acute hospitals increase with time from connection to the national reporting system, and are positively correlated with independently defined measures of safety culture, higher reporting rates being associated with a more positive safety culture.

Enhancing safety culture and event reporting: Insights from clinicians and administrators

“…The finding that fear, blame and lack of trust inhibited reporting of safety events is consistent with other studies [2,[26][27][28] and the concepts of whistleblowing in medicine [29] and nursing [30] and psychological safety [31] . Reporting of errors is a form of whistleblowing which is defined as a person who raises concern about wrongdoing [29] .…”

Comparison of case note review methods for evaluating quality and safety in health care

“…Others, particularly from the NHS staff survey, are known to be related to safety culture and incident reporting. 53 There are a number of positive correlations in the expected direction for holistic scale score and mean phase score data, although this is mainly for heart failure -there are only limited correlations for COPD holistic data. However, there were also a number of negative correlations for which it is dificult to ind an explanation.…”

“…These measures were selected from a much more extensive list through a process of group discussion, drawing also on the research team's experience in another study that examined the inluence of hospital-level process and outcome measures on incident reporting in acute hospitals. 53 Resource constraints and the dificulties of obtaining research governance and patient consent meant that, although desirable, it was not possible to obtain patient-level outcome data for the 1565 cases reviewed.…”

“…An example of a negative correlation would be an increase in COPD or heart failure score that correlates with a decrease in the number of incidents reported to the NPSA per 100 beddays (increased reporting is thought to indicate a positive safety culture 53 ). COPD mean holistic overall score (1 = unsatisfactory to 6 = very best care) Table 25 shows that there were only two moderate negative correlations.…”

“…) and patients with myocardial infarction (MI) receiving thrombolysis within an hour 46 • hospital-level proxy clinical outcome data, such as Hospital Standardised Mortality Ratio (HSMR) 50 • proxy measures of patient safety and safety climate, for example from the NHS Staff Survey 2006 51 and the National Patient Safety Agency (NPSA), 52 used in an evaluation of incident reporting levels to the Agency (these data items were selected from a larger set as a result of previous empirical research) 53 • external review data, such the ability of the hospital to meet national targets for quality, collected by the Healthcare Commission (HCC) for England.…”