Incident and error reporting systems in intensive care: a systematic review of the literature

PURPOSE: We performed a systematic review to assess (i) to what extent incident reporting systems (IRSs) on the adult intensive care unit (ICU) meet the criteria of the WHO Draft Guidelines for Adverse Event Reporting and Learning Systems, (ii) to what extent the IRSs comply with the four aspects of the iterative quality loop and (iii) whether IRSs have led to improvement measures in clinical practice. DATA SOURCES: The authors searched multiple electronic databases from 1966 until 26 June 2014. STUDY SELECTION: Studies were included if they reported incident reporting systems on the adult ICU. DATA EXTRACTION: Data on study design, characteristics of the incident reporting system, implementation, feedback and improvement measures were collected using structured data extraction forms. RESULTS OF DATA SYNTHESIS: A total of 2098 studies were identified and 36 studies reported IRSs on the adult ICU. Studies were divided into: ICU-specific IRSs and general IRSs. Items of the WHO checklist were assessed and categorized into the four phases of the iterative quality loop. CONCLUSION: None of the IRSs completely fulfilled the WHO checklist criteria. With respect to the iterative loop, data input and data collection are well established but not much attention was given to analyzing incidents and to give feedback. This resulted in an administrative report system, rather than the much desired instrument for change of practice and increase of quality as an IRS can only effectively contribute to improve patient safety and quality of care if more attention is given to analyzing incidents and feedback.