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Surgical adverse outcome reporting as part of routine clinical care
  1. J Kievit1,2,3,4,
  2. M Krukerink1,
  3. P J Marang-van de Mheen1,3,4
  1. 1Department of Medical Decision Making, Leiden University Medical Centre, The Netherlands
  2. 2Department of Surgery, Leiden University Medical Centre, The Netherlands
  3. 3Association of Surgeons of the Netherlands, Utrecht, The Netherlands
  4. 4Order of Medical Specialists, Utrecht, The Netherlands
  1. Correspondence to Prof Dr Job Kievit, Department of Surgery, Department of Medical Decision Making, Leiden University Medical Centre, J10-S, PO Box 9600, 2300 RC Leiden, The Netherlands; j.kievit{at}


Background In The Netherlands, health professionals have created a doctor-driven standardised system to report and analyse adverse outcomes (AO). The aim is to improve healthcare by learning from past experiences. The key elements of this system are (1) an unequivocal definition of an adverse outcome, (2) appropriate contextual information and (3) a three-dimensional hierarchical classification system.

Objectives First, to assess whether routine doctor-driven AO reporting is feasible. Second, to investigate how doctors can learn from AO reporting and analysis to improve the quality of care.

Methods Feasibility was assessed by how well doctors reported AO in the surgical department of a Dutch university hospital over a period of 9 years. AO incidence was analysed per patient subgroup and over time, in a time-trend analysis of three equal 3-year periods. AO were analysed case by case and statistically, to learn lessons from past events.

Results In 19 907 surgical admissions, 9189 AOs were reported: one or more AO in 18.2% of admissions. On average, 55 lessons were learnt each year (in 4.3% of AO). More AO were reported in P3 than P1 (OR 1.39 (1.23–1.57)). Although minor AO increased, fatal AO decreased over time (OR 0.59 (0.45–0.77)).

Conclusions Doctor-driven AO reporting is shown to be feasible. Lessons can be learnt from case-by-case analyses of individual AO, as well as by statistical analysis of AO groups and subgroups (illustrated by time-trend analysis), thus contributing to the improvement of the quality of care. Moreover, by standardising AO reporting, data can be compared across departments or hospitals, to generate (confidential) mirror information for professionals cooperating in a peer-review setting.

  • Adverse-effect
  • adverse-outcome
  • reporting
  • quality assurance, healthcare
  • lessons learnt
  • surgical context
  • The Netherlands
  • classification
  • statistics

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  • Funding Over the years funding for the nationwide development of the surgical adverse outcome registration was obtained from the Health Research and Development Council ZONMW (by grant number 16450001), from the Association of Surgeons of The Netherlands, and from the Order of Medical Specialists.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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