BMJ quality & safety
Multicenter Study Observational Study
We have designed a prospective adverse event (AE) surveillance method. We performed this study to evaluate this method's performance in several hospitals simultaneously. ⋯ This study demonstrated that it is possible to implement prospective surveillance in different settings. Such surveillance appears to be better suited to evaluating hospital safety concerns within rather than between hospitals as we could not definitively rule out whether the observed variation in AE risk was due to population or surveillance factors.
To examine how much of the variation between general practices in referral rates and cancer detection rates is attributable to local health services rather than the practices or their populations. ⋯ This is the first large-scale finding that a substantial proportion of the variation between general practitioner practices in referrals is attributable to their local healthcare systems. Efforts to reduce variation need to focus not just on individual practices but on local diagnostic service provision and culture at the interface of primary and secondary care.