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Since the publication of the US Institute of Medicine report "To err is human" 1 and the UK Department of Health report "An organisation with a memory," 2 there has been increasing recognition of the need for healthcare organisations to monitor and learn from patient safety incidents. Proposals on how to accomplish this have included the use of reporting systems, and over the last few years several countries have established national or system-wide reporting systems to facilitate large-scale monitoring and analysis of incident data. 3 - 5 The National Reporting and Learning System (NRLS) for England and in Wales, established by the National Patient Safety Agency, 6 was rolled out from late 2003 and has now received over one million reports, mainly from acute hospitals. 7
Although there may be benefits to be gained from the establishment of large reporting systems, 8 9 there are challenges that accompany their development, both at the individual reporting level and at the data-handling and analysis level. Many incidents still go unreported, with doctors being less likely than nurses to report. 10 11 Barriers to reporting include time constraints, lack of knowledge about how and what to report, fear of blame, lack of feedback and a perceived lack of value in the reporting process. 11 - 13 There are also technical challenges, such as connecting the national system to the many different local systems within health organisations, and developing a consistent framework for categorising incidents. 3 14 15 Furthermore, once the information has been captured, large amounts of data must be analysed so that meaningful feedback can be produced. 3 The World Health Organization Draft Guidelines for Adverse Event Reporting and Learning Systems 8 identify a range of analytical approaches, including correlations and trend and cluster analyses, that might be used to identify patterns and assess risks.
All acute hospitals in England are now beginning to report to the National Reporting and Learning System, having been progressively connected to the system over a period of about 2 years. However, even taking into account the differential timetables for connection, it is clear that some organisations are reporting higher numbers of incidents than others. 7
The National Reporting and Learning System is not the only quality and safety system to...