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Trends in healthcare incident reporting and relationship to safety and quality data in acute hospitals: results from the National Reporting and Learning System
  1. A Hutchinson1,
  2. T A Young1,
  3. K L Cooper1,
  4. A McIntosh1,
  5. J D Karnon1,
  6. S Scobie2,
  7. R G Thomson2
  1. 1
    Section of Public Health, ScHARR, University of Sheffield, Regent Court, Sheffield, UK
  2. 2
    National Patient Safety Agency, London, UK
  1. Professor A Hutchinson, Section of Public Health, ScHARR, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK; allen.hutchinson{at}


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 risk-management 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.

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  • See Editorial, p 2

  • Funding: Funding for the study was provided by the National Patient Safety Agency to the University of Sheffield.

  • Competing interests: SS and RT were responsible for commissioning this work on behalf of the National Patient Safety Agency.

  • AH wrote the research proposal, directed the study and contributed to analysis and writing; TY undertook much of the analysis and contributed to the writing; KC managed the research process, undertook some analysis and contributed to the writing; AM undertook the qualitative evaluation and contributed to the findings; JK contributed to the design and analysis; SS and RT proposed the project and contributed to design, writing and interpretation.

  • The National Patient Safety Agency “National Learning and Reporting System” (NRLS): more information on the NRLS, including data on types of incidents and severity, is available at:

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