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Connecting perspectives on quality and safety: patient-level linkage of incident, adverse event and complaint data
  1. Marit S de Vos1,2,
  2. Jaap F Hamming1,
  3. Jolanda J C Chua-Hendriks1,
  4. Perla J Marang-van de Mheen2
  1. 1 Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
  2. 2 Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
  1. Correspondence to Dr Perla J Marang-van de Mheen, Department of Biomedical Data Sciences, J10-S, Leids Universitair Medisch Centrum, Leiden, 2300 RC, The Netherlands; p.j.marang{at}


Background and objective Incident, adverse event (AE) and complaint data are typically used separately, but may be related at the patient level with one event triggering a cascade of events, ultimately resulting in a complaint. This study examined relations between incidents, AEs and complaints that co-occurred in admissions.

Methods Independently and routinely collected incident, AE and complaint data were retrospectively linked for surgical admissions in an academic centre (2008–2014). Two investigators reviewed whether incidents/AEs in admissions were clinically related and in what sequence (incident preceding vs following AE). Likelihood of occurrence of AEs and AE cascades (ie, ≥3 AEs) was studied using logistic regression analyses.

Results Complaints were filed for 33 (0.1%) of 26 383 admissions. Complaints filed by patients with incidents and/or AEs (n=13) mostly addressed quality/safety problems, whereas other complaints mostly addressed relationship problems. Incidents and AEs co-occurred in 730 (2.8%) admissions, which seemed clinically related in 34% of these cases. Incidents with related AEs preceded as well as followed AEs (56.6%/44.4%). Patients with incidents were at greater risk of AEs than patients without incidents, even for seemingly unrelated AEs (OR 1.4; 95% CI 1.3 to 1.6). Risk of AE cascades was greater when patients with AEs also had incidents, regardless of whether these seemed related (unrelated: OR 2.0; 95% CI 1.6 to 2.5; related: OR 5.7; 95% CI 4.3 to 7.4) or whether incidents preceded or followed AEs in these admissions (53% vs 52%, P>0.05).

Conclusions Patient-level linkage of incident, AE and complaint data can reveal relations between events that otherwise remain obscured, such as incidents that trigger as well as follow AEs, introducing event cascades, regardless of whether clinical relations seem present.

  • quality improvement
  • quality measurement
  • patient safety
  • incident reporting
  • adverse events, epidemiology and detection

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  • Contributors All authors contributed to conception and design of this study. MSdV and JJCC-H analysed the data, and MSdV, JFH and PJM-vdM interpreted the results. MSdV drafted the article and all other authors (JFH, JJCC-H, PJM-vdM) participated in revising it critically. All authors have seen and approved the final draft. All authors received access to all the data (including statistical reports and tables) in the study and take responsibility for the integrity and the accuracy of the data analysis. PJM-vdM is guarantor.

  • Funding MSdV was supported by a combined unrestricted grant from the board of directors of the Leiden University Medical Centre, The Vogelgezang Foundation (no. 1519-01), Leiden University Fund (no. 5265/12-11-15) and the Michäel-Van Vloten Surgery Fund. Funders had no role in the study design; data analysis and interpretation; in the writing of the report; or in the decision to submit the article for publication.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval The local ethics committee waived the requirement for approval based on Dutch national law.

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

  • Data sharing statement No additional data are available.

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