SPIEGEL

In September 2006 SPIEGEL-study was started at the University Medical Centre Utrecht. It is a study on patient safety by incident evaluation in primary care. The acronym means mirror, which points to the overall aim of systematic reflection on own incidents in primary care.

The first objective of the study was to explore outcome, feasibility and effect of an incident reporting procedure as a tool to improve patient safety in different GP settings. Therefore this tool was implemented in 5 large health care centres and in one GP out of hours service.
A second objective of SPIEGEL was exploring incidents which residents were involved in during their GP vocational training. The aim was to identify barriers and facilitators which could be used to improve safety during GP residency.

The incident reporting procedure (IRP) of SPIEGEL is a report and learning cycle, based on continiously, blamefree, confidential reporting to a decentral, multidisciplinary committee trained in systematic analysis of incidents. Methods of incident analysis are Root Cause Analysis and PRISMA. Incident is defined as every unintended event which caused harm, could have caused harm, or will cause harm to the patient. Other important aspects of the IRP are instant feedback to the reporter and regular, anonym feedback about incidents, analysis and improving measures to the participating GP setttings. Data of the incidents are anonymized and gathered in a research database. 
In the GP vocational training setting participating GP residents will report their incidents to the researcher. The incident will be analysed by the researcher together with the reporter. Data will be qualitatively studied.

The study is funded by the SBOH and the UMC Utrecht. The SBOH is the general financer of the Dutch GP vocational training and the employer of all GP residents in The Netherlands. It is funded from September 1th 2006 untill April 1th 2009. Dorien Zwart, GP en researcher at both the Julius Centre and the Patient Safety Centre of the UMCU, is leading the SPIEGEL project.

First results will be presented for publication to general medicine journals or GP journals in 2009.

D.L.M. Zwart, MD (Education - General Practice Vocational Training, UMC Utrecht)
Prof. C.J. Kalkman, MD (Anesthesiology, UMC Utrecht)
Prof. Th.J.M. Verheij, MD (General Practice, UMC Utrecht)
Dr. E.L.J. van Rensen (Patient Safety Center, UMC Utrecht)