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Incident reporting: rare incidents may benefit from national problem solving
  1. Ann-Marie Howell1,
  2. Elaine M Burns2,
  3. Louise Hull3,
  4. Erik Mayer1,
  5. Nick Sevdalis4,
  6. Ara Darzi1
  1. 1Department of Surgery and Cancer, Imperial College, London, UK
  2. 2Department of Biosurgery and Surgical Technology, Imperial College London, London, UK
  3. 3Division of Surgery, Imperial College London, London, UK
  4. 4Department of Surgery and Cancer, Imperial College London, London, UK Health Service and Population Research, Centre for Implementation Science, King's College, London, UK
  1. Correspondence to Ann-Marie Howell, Department of Surgery and Cancer, Imperial College, London W2 1NY, UK; a.howell{at}

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We would like to congratulate the authors on the pragmatic nationwide approach that they have adopted in Denmark to address the key issues around incident reporting. Rabol and colleagues1 highlight again the challenges of collecting and meaningfully using such data.

Though experts in Denmark have drawn many of the same conclusions reached in our Delphi exercise,2 it is interesting that our findings differed on the usefulness of incident reports to detect rare events. The Danish Society concluded that rare events are difficult to detect due to deficiencies in data mining and that efforts are better spent solving known safety problems at a local level. Undoubtedly, the management of ‘big data’ is challenging, and one must consider carefully resource allocation at national and local levels. One of the initial ‘burning platforms’ driving the creation of the National Reporting and Learning System (NRLS) in England, however, was the very rare but fatal misadministration of vincristine, an incident that occurred 14 times in different hospitals without any shared learning. The NRLS collated incidents and recognition of the problem led to critical design solutions to prevent against future events.3 ,4 This initial success drove the ambitions of reporting systems to provide national solutions to safety issues.

The experts in our study concur with your stakeholders that there should be greater focus on local action to local problems, so that there is greater engagement from staff and reduced time lag with the inevitable inertia as a result of waiting for a national response. However, as your first recommendation suggests new and rare serious events should be conveyed nationally so that ideas can be pooled. Some events such as device failures benefit from a rapid, coordinated, regulatory response that can filter to the front line to safeguard patients.

As you discussed the main barrier to this is the issue of mining reporting data for rare events. The noise-to-signal ratio is high and manual data mining is unfeasible, given the volume of reports. Automated electronic clinical record mining using natural language processing (NLP) methods is a promising field of research that may provide a computing solution to extracting useful safety data from narrative systems. One of the Australian state reporting systems (the Advanced Incident Management System) had made inroads in this using NLP classifiers to detect specific types of incidents described in the free text reports, a technique we, in England, are currently trying to apply to the NRLS.5

Since clinical computing methodology lags behind commercial automated text mining, resources should be preferentially focused at the local reporting level. However, we hope that future systems will have the computational algorithms to provide safety reporting data regarding rare, serious incidents so that national problem solving can continue and it remains a laudable aim.



  • Competing interests None declared.

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

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