Incident reporting should ideally communicate all information relevant to patient safety. Local incident reporting systems in hospitals typically use an incident form that comprises basic clinical details and a brief description of the incident; there may be a list of designated incidents that should always be reported. Such systems are ideally used as part of an overall safety and quality improvement strategy, but in practice they may be dominated by managing claims and complaints.1

Specialty reporting systems2 and large scale systems, such as that of the UK National Patient Safety Agency (www.npsa.nhs.uk/), allow wider dissemination of lessons learnt and emphasise the need for parallel analysis and development of solutions. In this week's BMJ a case note review by Sari and colleagues finds that local reporting systems are poor at identifying patient safety incidents, particularly those involving harm,3 echoing the findings of similar studies.4 Does this mean that these reporting systems are of no value? It depends entirely on …