The National Reporting and Learning System
The National Reporting and Learning System, or the NRLS as most refer to it as, was designed from around 2001 when the National Patient Safety Agency was launched. Numerous options were considered for the collection of adverse events. During this time the term adverse events was replaced with ‘patient safety incidents’ and the guidance ‘Seven Steps to Patient Safety’ described the levels of a patient safety incident from no harm through to death.
The aim was to connect the national system to all local risk management systems to try to minimise the burden on frontline staff from having to report twice (to the hospital system and to the national system). We employed 33 patient safety managers who (amongst all their other duties) travelled the length and breadth of the country helping individual risk managers map their datasets to the national dataset. The NHS doesn’t have a great track record with IT systems but this one has to be seen as one of the successes. It captures from across England and Wales anything that is reported into the local risk management system day in day out.
The system now collects over a million incidents a year. This needs some context. The vast majority are no harm (the equivalent of high risk industries ‘near miss’) and low harm events; these are indicators of the level of risk in the system. Also this is within the environment of activity which includes:
- Over 1 million patients seen every 36 hours
- Around 10m operations every year and 22 million attendances to A/E per year
There were some really interesting reflections on the successes and failures of the NRLS.
One of the most astonishing was that clostridium difficile was spelt 371 different ways in NRLS reports.
This makes it very hard when you want to (as the analysts say) interrogate the data – putting in 371 key words for a search on incidents related to clostridium difficile is somewhat tricky. This is also only one example – when free text is used in a reporting system there will always be multiple ways in which a single issue can be described.
The usual things were found:
- Variation in reporting strategies
- Variations in coding the level of severity – which is often subjective
- Poor data quality
- Limited incidents on anything out of hospitals
- Poor feedback systems
All leading to a difficulty in knowing quite what the NRLS is telling us
The complexities of incident reporting systems are beautifully captured by Carl Macrae’s ‘The problem with… incident reporting’ in the BMJ Quality and Safety journal that really all you need to do is go and read this.
We have posted the link to this on the Sign up to Safety website. https://www.england.nhs.uk/signuptosafety/latest-thinking/