It can be taught to and used by researchers, clinicians and managers. In the Netherlands, many hospitals start using PRISMA to study events reported by their staff. Most hospitals are taking on decentralised (department-level) event reporting with in each department a special committee that has the task to analyse the reported events, give staff feedback and design and implement improvements. Recommendations for future research While in most Alectinib datasheet unintended events in our study no harm for the patient was involved, only a Inhibitors,research,lifescience,medical small number of the unintended events would have met the criteria of an adverse event: 1) an unintended (physical

and/or mental) injury which 2) results in temporary or permanent disability, death or prolongation of hospital stay, and is 3) caused by health care management rather than the patient’s disease. The events in our study were not assessed by physician reviewers on these criteria. It is unclear whether the results regarding the causes of the broad group of unintended events we examined are also applicable to the specific Inhibitors,research,lifescience,medical Inhibitors,research,lifescience,medical group of adverse events. Although the common cause hypothesis of near misses and accidents is supported by research in the railway sector[15], future research is needed to examine the resemblance of the causal factor structures of unintended events and adverse events in the healthcare domain. Our study mainly gives an idea about events Inhibitors,research,lifescience,medical related

to nursing care. To get a more complete view of all unintended events that occur, we recommend expanding the reporting of events with patient record review.

The report of Wagner et al.[32] showed that there was almost no overlap in the events reported by staff and the events identified trough patient record review. The unintended events identified in patient Inhibitors,research,lifescience,medical records were more often related to medical care by physicians, than the events that were reported by staff. Record review can be considered as an important additional source to voluntary reporting of unintended events, primarily to find more unintended events related to these physician/specialist care. Conclusion Our study shows that event reporting gives insight into diverse unintended events that occur within healthcare, especially nursing care. The majority of unintended events had no consequences for the patient or resulted only in minor patient inconvenience. However, since large numbers of patients visit the ED, the accumulated effect of the events on patient well-being and the healthcare delivery system is likely to be large. The information on unintended events may help target research and interventions to increase patient safety. It seems worthwhile to direct interventions on the collaboration between the ED and other hospital departments, because a large number of unintended events occur in the collaboration with departments outside the ED and nearly half of all causes were external.