Open Access Research article

Retrospective record review in proactive patient safety work – identification of no-harm incidents

Kristina Schildmeijer1*, Maria Unbeck2, Olav Muren2, Joep Perk1, Karin Pukk Härenstam34 and Lena Nilsson5

Author affiliations

1 School of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden

2 Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Division of Orthopaedics, Stockholm, Sweden

3 Karolinska Institutet, Medical Management Centre, Stockholm, Sweden

4 Division of Paediatrics, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden

5 Department of Anesthesia and Intensive Care, County Council of Östergötland, Linköping University, Linköping, Sweden

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Citation and License

BMC Health Services Research 2013, 13:282  doi:10.1186/1472-6963-13-282

Published: 22 July 2013



In contrast to other safety critical industries, well-developed systems to monitor safety within the healthcare system remain limited. Retrospective record review is one way of identifying adverse events in healthcare. In proactive patient safety work, retrospective record review could be used to identify, analyze and gain information and knowledge about no-harm incidents and deficiencies in healthcare processes. The aim of the study was to evaluate retrospective record review for the detection and characterization of no-harm incidents, and compare findings with conventional incident-reporting systems.


A two-stage structured retrospective record review of no-harm incidents was performed on a random sample of 350 admissions at a Swedish orthopedic department. Results were compared with those found in one local, and four national incident-reporting systems.


We identified 118 no-harm incidents in 91 (26.0%) of the 350 records by retrospective record review. Ninety-four (79.7%) no-harm incidents were classified as preventable. The five incident-reporting systems identified 16 no-harm incidents, of which ten were also found by retrospective record review. The most common no-harm incidents were related to drug therapy (n = 66), of which 87.9% were regarded as preventable.


No-harm incidents are common and often preventable. Retrospective record review seems to be a valuable tool for identifying and characterizing no-harm incidents. Both harm and no-harm incidents can be identified in parallel during the same record review. By adding a retrospective record review of randomly selected records to conventional incident-reporting, health care providers can gain a clearer and broader picture of commonly occurring, no-harm incidents in order to improve patient safety.

Retrospective record review; Incidents; Patient safety; Harvard medical practice study method