Table 2

 Desirable attributes of an integrated system: underlying principles

Notes on terms:20
*Incident: any event or circumstance which could have or did harm anyone or which resulted in a complaint, loss or damage.
†Near miss: an incident which did not harm anyone or lead to a complaint, loss or damage.
‡Adverse event: an incident which harmed a patient.
§Sentinel event: an adverse event which definitely should not have occurred.
¶For example, it does not matter whether different jurisdictions have different definitions for a near miss. One might regard a near miss as an incident without any adverse outcome, and another might regard a near miss as an incident that was intercepted before the sequence of actions was completed. If the actual information about what happened is collected, then such definitions can be applied retrospectively in the relevant jurisdiction and need not bother a reporter or classifier, nor constrain what is collected.
The system should:
• be based on an underlying information model consistent with those used in other high risk industries such as aviation, rail, oil rigs, and nuclear power
• be supported by a comprehensive, universal patient safety classification
• be able to elicit, classify, store, analyze and manage things that go wrong (incidents)* across the entire spectrum of health care from near misses† to adverse‡ or sentinel events§
• be able to accommodate information from all available sources
• be populated by concepts shown to be needed from “real world” data
• be expansible as needs for new concepts become evident
• be able to collect information without being constrained by definitions about the type of event or circumstance¶
• be able to be used by funders, administrators, providers, carers, patients, and other clients or consumers
• complement other members of the Family of International Classifications of the World Health Organization by incorporating subsets of concepts or cross-mapping directly where relevant