gms | German Medical Science

19. Deutscher Kongress für Versorgungsforschung

Deutsches Netzwerk Versorgungsforschung e. V.

30.09. - 01.10.2020, digital

Establishing incident reporting in primary care – a hard nut to crack?

Meeting Abstract

  • Dagmar Lüttel - Aktionsbündnis Patientensicherheit, Berlin, Deutschland
  • Hardy Müller - Techniker Krankenkasse
  • Beate Müller - Institut für Allgemeinmedizin, Goethe Universität Frankfurt am Main
  • Marina Pommee - Institut für Allgemeinmedizin, Goethe Universität Frankfurt am Main
  • Dania Schütze - Institut für Allgemeinmedizin, Goethe Universität Frankfurt am Main
  • Tatjana Blazejewski - Institut für Allgemeinmedizin, Goethe Universität Frankfurt am Main
  • Katharina Rubin - Techniker Krankenkasse
  • Romy Schadewitz - Ärztliches Zentrum für Qualität in der Medizin (ÄZQ), Berlin, Deutschland
  • Christian Thomeczek - Ärztliches Zentrum für Qualität in der Medizin (ÄZQ), Berlin, Deutschland
  • Martin Beyer - Institut für Allgemeinmedizin, Goethe Universität Frankfurt am Main
  • Andreas Kintrup - Kassenärztliche Vereinigung Westfalen-Lippe, Dortmund, Deutschland
  • Reiner Heuzeroth - Asklepios Kliniken GmbH, Hamburg, Deutschland

19. Deutscher Kongress für Versorgungsforschung (DKVF). sine loco [digital], 30.09.-01.10.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. Doc20dkvf123

doi: 10.3205/20dkvf123, urn:nbn:de:0183-20dkvf1231

Veröffentlicht: 25. September 2020

© 2020 Lüttel et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe



Background and current state of (inter)national research: General practice is the most common place for patient interaction in the health service.

In Germany, practice settings are obliged to have incident reporting and learning systems in place as they are key to improving patient safety and preventing the occurrence of harm. However, reporting is low. Since 2004, only about 1000 incident reports have been submitted to the national reporting system for general practice[1]. In England and Wales there is a good reporting culture. The National Reporting and Learning System (NRLS) has been established in 2003. The system receives over two million reports each year. However, the majority of incidents is being reported by hospital staff (about 1.5 Million per year; 73%), only a small proportion is being reported from general practice (about 7,000 per year; 0%)[2].

Research questions and objectives: The project was carried out to develop and validate a concept to promote the use of reporting systems in practice settings. The key questions were:

  • How can practice staff be convinced to regularly use a reporting and learning system?
  • Which supporting measures are accepted and found to be helpful?
  • Does the safety culture in participating practices change over time?

Methods or hypothesis: Over 17 months, 184 practices were supported with various measures, e.g.

  • Introductory workshops and E-learning modules
  • Templates for reporting and analysing incidents
  • Web-based seminars to discuss problems and solutions with peers
  • Telephone hotline for queries
  • Monthly info-mails
  • Project homepage

The methods used to evaluate the supporting measures were

  • Two Questionnaires to assess the safety culture of the practice teams
  • Three short questionnaires to gather information about the status of the incident reporting system
  • Incident reports
  • Qualitative interviews with 40 practices.

Results: In the course of the project, participant’s knowledge about how to report and analyse patient safety incidents improved significantly. At the beginning of the study only 45% of the practices used a system for reporting incidents, in the end it was 91.3%. The findings showed which supporting measures for the implementation of incident reporting are accepted and found to be helpful by practice staff. Practices participated in digital measures like e-learning and web-based seminars more than expected. For many practices it was sufficient if error reports were treated confidentially, anonymity did not necessarily have to be guaranteed.

Discussion: The results can help to establish incident reporting in practice settings. It is also important for other researchers to know which measures were successful and which were not.

Practical implications: Practice teams need additional skills in the field of patient safety; web-based trainings and seminars are feasible and attractive for practice staff. Constant external support and peer group discussions are beneficial and a responsible person within the practice team is crucial.