Patient safety incident management system

A new national NHS patient safety incident management system (PSIMS) is in the final stages of development as a central service for the recording and analysis of patient safety events that occur in healthcare.

The new service will replace the current National Reporting and Learning System (NRLS) and Strategic Executive Information System (StEIS), offering better support for staff from all health and care sectors to record safety events, and providing greater insight and analysis to aid national and local safety improvement.

Recording safety events to a national service

Recording safety events, whether they result in harm or not, provides vital insight into what can go wrong in healthcare and the reasons why.

At a national level, this allows for new or under-recognised safety issues to be quickly identified and acted upon on an NHS-wide scale, ensuring providers across the country take action to reduce the risk. It also provides a wealth of data offering essential insight to support ongoing national patient safety improvement programmes, as well as improvement work at a more local or speciality-specific level (find out more about how we use patient safety incident recording at a national level).

What PSIMS will do

The new PSIMS system is a major upgrade, creating a single national NHS system for recording patient safety events. It will introduce improved dimensions for the analysis of patient safety events occurring across healthcare, and enable better use of the latest technology, such as machine learning, to create outputs that offer a greater depth of insight and learning and are more relevant to the current NHS environment.

When fully functional, PSIMS will:

  • make it easier for staff across all healthcare settings to record safety events, with automated uploads from local systems to save time and effort, and introducing new tools for non-hospital care where reporting levels have historically been lower
  • collect information that is better suited to learning for improvement than what is currently gathered by existing systems
  • make data on safety events easier to access, to support local and specialty-specific improvement work
  • utilise new technology to support higher quality and more timely data, machine learning, and provide better feedback for staff and organisations.

At present, around three quarters of reporting to the NRLS and StEIS is from the hospital sector. The new safety learning service will make recording safety events in other care settings, including primary care, easier, through the introduction of simple online forms, and log-in access to review and update previously recorded incidents. This will also support good incident response practice, by allowing smaller organisations to see all their safety events through one dashboard.

Lucie Musset, product owner for PSIMS, describes what the new system will do and how it will benefit patient safety.

Developing PSIMS

PSIMS has been developed with staff from all health and care settings, following best-practice agile development methodology, and adheres to the Government Digital Service Standard. This means that design decisions are made around how best to meet specific user needs. It also means the service is developed one step at a time, so different functions will become available at different points, and the roll-out process will be a gradual one. The next phase of this process is called public beta.

Public beta and further roll out

PSIMS will shortly enter its public beta stage. This means that organisations with compatible local reporting systems can begin to use the new system during a final extended piloting stage instead of using the NRLS.

Throughout this period, new functionality will be added to the service as it is developed, and to continue to meet any newly identified user needs. This will include:

  • enhanced tools for accessing and visualising data, for the public, providers and national bodies
  • enhanced feedback mechanisms and learning outputs
  • online forms so that patients and their representatives can report safety events directly (the NRLS Patient eForm will remain available for use until new online forms are fully developed).

Current timescales for introducing PSIMS are:

  • Public beta phase commences – PSIMS available to NHS and independent sector providers with compatible LRMS, and other providers using the online service (Q4 2020/21)
  • Public beta transition – providers move from NRLS to PSIMS as their LRMS compatibility upgrades become available – see ‘preparing for PSIMS’ section below (estimated mid 2022)
  • Live phase – once all providers have transitioned from NRLS to PSIMS, the service is officially live. Continuous improvements will be made throughout (timing TBC – dependent on roll out of compatible local risk management systems – see below).

We will add to this page with further updates, supporting information and resources as we progress through the final stages of PSIMS development.

If your organisation is interested in being part of the public beta phase, please contact us by emailing patientsafety.enquiries@nhs.net.

Preparing for PSIMS

Larger NHS organisations, such as trusts and foundation trusts, usually have a dedicated local risk management system (LRMS) for reporting incidents. Incident data is then uploaded onto the national NHS system (currently the NRLS).

LRMS suppliers are rolling out a programme of upgrades to move organisations onto products that will be compatible and compliant with PSIMS, supporting two-way communication between local and national systems, and allowing automated data sharing. Providers should contact their LRMS supplier for further details.

As LRMS vendors achieve PSIMS compliance, we will publish a list of those offering PSIMS-compatible products.

Smaller organisations such as general practice, independent dental surgeries and opticians, may not have their own LRMS. In these organisations, staff will be able to begin recording patient safety events directly to PSIMS through the web-based service, from the start of public beta.

Staff who report incidents using NRLS staff eForms will be redirected to PSIMS and asked to register for a PSIMS account. They will still be given the option to record anonymously.

To support local safety governance, response and improvement, PSIMS will also offer organisations without an LRMS the ability to assign individuals access to data on all safety events recorded within their organisation.

Accessing data from PSIMS

Providers sharing details of patient safety events with PSIMS will be able to access their own data, in line with how they currently access NRLS data. We will also continue to publish national aggregated data for both NRLS and PSIMS while they exist in parallel.

Over time, we will develop self-service tools to support routine and ad hoc analysis of national PSIMS data, in line with our agenda of transparency, and to facilitate more opportunities to derive improvement insight from the information we hold, and to share learning outputs across the NHS.

Additional information

For further information about PSIMS and the Beta service you can also view a PSIMS show and tell video recorded in July 2020.