Transitional safety incidents as reported by patients and healthcare professionals in the Netherlands: A descriptive study

Figures & data

Table 1. Flowchart of data sources and number of reported TSIs by patients and healthcare professionals.

	Period of data collection	Number of participants	Number of reported TSIs^a
Total number of participants		703	548
Patients		470	411
Survey (TRIQ)	2014–2015	239^b	399
Interview	2013–2014	13^c	9^d
Reporting weeks	2014–2015	4	3
Healthcare professionals		233	137
Incident reporting systems	2011–2014	44	30
Case reports	2014	74^e	69
Focus groups	2014	98^f	21
Reporting weeks	2014–2015	17	17

TSI: transitional safety incident; TRIQ: Transitional Risk and Incident Questionnaire.

^a One participant could report on more than one incident. This is the number of reported TSIs after exclusion when the incident was not deemed transitional.

^b 239 of 454 patients completed the TRIQ questionnaire; response = 53%.

^c 19 patients signed up for an interview; non-response in six patients, reasons: deemed too sick; language barrier; no incident; living too far away; not able to reach patient. Patients’ age ranged from 6 (of whom the parents were interviewed) to 82 years, the median age was 60 years.

^d One patient reported two TSIs.

^e 300 healthcare professionals were approached; response = 25%.

^f 98 healthcare professionals participated in 12 focus groups: seven groups with GPs, five with hospital specialists.

Figure 1. Classification by severity of transitional safety incidents according to NCC-MERP index. Category A: unsafe situation (no error); these concern events that have the capacity to cause error. Category B: near miss (error, no harm); an error occurred but did not reach the patient. Category C: near miss (error, no harm); an error occurred that reached the patient but no harm was caused. Category D: near miss (error, no harm); an error occurred, reached the patient and required monitoring/intervention to preclude harm. Category E: adverse event (error and harm); error that may have contributed/resulted in temporary harm and required intervention. Category F: adverse event (error and harm); error that may have contributed to or resulted in temporary harm and required initial or prolonged hospitalization. Category G: adverse event (error and harm); error that may have contributed to or resulted in permanent harm. Category H: adverse event (error and harm); error that required intervention necessary to sustain life. Category I: adverse event (error and death); error that may have contributed to or resulted in patient’s death.

Table 2. Classification of 368 of 548 TSIs into aspects of the care transition process, stratified per data source.

	Total		TRIQ		Interviews		Reporting weeks		Focus groups		Case reports		Reporting system
Total number of classifications^a	n = 672		n = 420		n = 22		n = 37		n = 45		n = 110		n = 38
1. Handover correspondence to GP	172	25.6%	99	23.6%	6	27.3%	12	32.4%	12	26.7%	24	21.8%	19	50.0%
2. Referral correspondence from GP to hospital	97	14.4%	78	18.6%	0	0%	2	5.4%	5	11.1%	12	10.9%	0	0%
3. Communication/collaboration^c	93	13.8%	57	13.6%	0	0%	8	21.6%	6	13.3%	17	15.5%	5	13.2%
4. Diagnostic testing	91	13.5%	87	20.7%	1	4.5%	0	0%	1	2.2%	2	1.8%	0	0%
5. Medication prescription	72	10.7%	33	7.9%	2	9.1%	4	10.8%	7	15.6%	22	20.0%	4	10.5%
6. Assignment of responsible physician	52	7.7%	45	10.7%	1	4.5%	1	2.7%	1	2.2%	3	2.7%	1	2.6%
7. Discharge process^b	23	3.4%	7	1.7%	2	9.1%	2	5.4%	1	2.2%	7	6.4%	4	10.5%
8. Diagnostic reasoning	22	3.3%	2	0.5%	3	13.6%	3	8.1%	7	15.6%	6	5.5%	1	2.6%
9. Accessibility of care	14	2.1%	8	1.9%	1	4.5%	2	5.4%	0	0%	2	1.8%	1	2.6%
10. Involvement of multiple hospitals	10	1.5%	2	0.5%	2	9.1%	1	2.7%	1	2.2%	3	2.7%	1	2.6%
11. Triage of urgency	7	1.0%	0	0%	2	9.1%	0	0%	1	2.2%	2	1.8%	2	5.3%
12. Out-of-hours care	6	0.9%	0	0%	1	4.5%	0	0%	0	0%	5	4.5%	0	0%
13. Involvement of multiple specialties	6	0.9%	0	0%	1	4.5%	1	2.7%	1	2.2%	3	2.7%	0	0%
14. Internal referral	4	0.6%	1	0.2%	0	0%	1	2.7%	0	0%	2	1.8%	0	0%
15. Registration (administration)	2	0.3%	1	0.2%	0	0%	0	0%	1	2.2%	0	0%	0	0%
16. Self-care advice after discharge	1	0.1%	0	0%	0	0%	0	0%	1	2.2%	0	0%	0	0%

TRIQ: Transitional Risk and Incident Questionnaire; GP: general practitioner; TSI: transitional safety incident.

^a One incident could be classified into more than one aspects of the care transition process, for example, handover correspondence to the GP and medication prescription.

^b Other than correspondence.

^c Besides written communication.

Table 3. Classification of 368 of 548 TSIs into aspects of care transition process, stratified for patients and healthcare providers.

	By patients		By healthcare professionals
Aspects of the care transition process^a	n = 449^a		n = 223
1. Handover correspondence to GP	106	23.6%	66	29.6%
2. Referral correspondence from GP to hospital	78	17.4%	19	8.5%
3. Communication/collaboration	58	12.9%	35	15.7%
4. Diagnostic testing	88	19.6%	3	1.3%
5. Medication prescription	37	8.2%	35	15.7%
6. Assignment of responsible physician	46	10.2%	6	2.7%
7. Discharge process^a	10	2.2%	13	5.8%
8. Diagnostic reasoning	6	1.3%	16	7.2%
9. Accessibility of care	9	2.0%	5	2.2%
10. Involvement of multiple hospitals	5	1.1%	5	2.2%
11. Triage of urgency	2	0.4%	5	2.2%
12. Out-of-hours care	1	0.2%	5	2.2%
13. Involvement of multiple specialties	1	0.2%	5	2.2%
14. Internal referral	1	0.2%	3	1.3%
15. Registration (administration)	1	0.2%	1	0.4%
16. Self-care advice after discharge	0	0%	1	0.4%

GP: general practitioner; TSI: transitional safety incident

^a A TSI could be classified into more than one aspects of the care transition process.

^b Other than written correspondence

Table 4. Classification of 191 of 548 TSIs by cause according to the Eindhoven Classification Model (ECM), stratified for the different data sources.

	Total		TRIQ		Interviews		Reporting weeks		Focus groups		Case reports		Reporting system
Causes	n = 493		n = 299		n = 34		n = 88		n = 37		n = 11		n = 24
Technical	4	0.8%	0	0%	0	0%	1	1.1%	2	5.4%	0	0.0%	1	4.2%
Organizational	104	21.1%	11	3.7%	14	41.2%	40	45.5%	22	59.5%	5	45.5%	12	50.0%
Human	93	18.9%	6	2.0%	17	50.0%	41	46.6%	12	32.4%	6	54.5%	11	45.8%
Patient-related	9	1.8%	4	1.3%	2	3.1%	2	2.3%	1	1.4%	0	0%	0	0%
Unclassifiable	283	57.4%	278	93.0%	1	1.5%	4	4.5%	0	0%	0	0%	0	0%

TRIQ: Transitional Risk and Incident Questionnaire.