Safety Incident Reporting in Chiropractic: A descriptive analysis of an active and passive system

In the world of healthcare, safety is defined by the absence of preventable harm. When something goes wrong—a medication error, a delayed diagnosis, or an unexpected reaction to treatment—it is called a safety incident. To prevent these events from happening again, medical professionals rely on reporting systems. These are the mechanisms through which doctors, nurses, and therapists document what went wrong so that patterns can be found and lessons can be learned. There are two main ways these systems work. One is passive, like a suggestion box where staff voluntarily write down what happened, often without revealing their names. The other is active, where researchers or administrators systematically ask patients and providers specific questions to hunt down incidents that might otherwise go unnoticed. While hospitals have long used these tools, the field of chiropractic care, which focuses on the spine and nervous system, has been slower to develop a clear picture of how its own safety reporting works.

A team of researchers from universities and colleges across North America and Europe set out to examine two specific systems used in the chiropractic profession to see how they measure up against international standards. One system, called CPiRLS, is a passive, anonymous platform where chiropractors voluntarily report incidents. The other, SafetyNET, is an active system embedded within research studies, where patients and practitioners are systematically asked about their experiences after treatment. The researchers did not treat these as rivals competing for the same job. Instead, they viewed them as two different tools designed for different purposes, and they wanted to know if, together, they could cover the full spectrum of patient safety better than either could alone.

To evaluate these systems, the team used a detailed checklist created by the World Health Organization. This checklist acts as a blueprint for what a good safety system should look like, covering everything from how easy it is to file a report to how well the system involves patients and families in the process. The researchers also checked the specific data fields in the reports—such as the patient's age, the location of the incident, and the outcome—to see if they matched a global standard for the minimum information needed to learn from an event. They brought together experts, including the leaders of both systems, to score each system against these criteria, discussing their findings until they reached a consensus.

The analysis revealed that neither system was perfect, but they were not identical in their flaws. In fact, their weaknesses often complemented each other. The passive system, CPiRLS, excelled at protecting the identity of the person reporting. Because it was fully anonymous, chiropractors felt safe reporting a wide range of issues, from minor slips to serious diagnostic errors, without fear of blame. However, because the reporters remained anonymous, the system could never follow up with them to ask for more details or provide personalized feedback on what they learned.

The active system, SafetyNET, worked in the opposite way. Because it was part of a research study, the researchers could contact the reporters to gather more information, which allowed for a deeper understanding of specific events. It also captured the patient's perspective directly, rather than relying solely on the chiropractor's view. However, this system was limited to tracking new or worsening symptoms that occurred during the study period. It missed broader safety concerns, such as a patient tripping in the waiting room or a failure to recognize a serious underlying disease, because its design focused strictly on the treatment response.

When the researchers looked at the data fields, they found that the two systems captured different pieces of the puzzle. CPiRLS used a structured list to categorize the type of incident and the severity of harm, making it easy to sort and compare different events. SafetyNET, on the other hand, tracked the patient's pain levels over time with great precision but lacked a formal way to categorize the type of incident. Similarly, SafetyNET was excellent at recording the patient's age and sex, while CPiRLS only recorded age in broad groups. Neither system was perfect at recording where the incident happened or what exactly caused it, and neither used a standardized code to describe the contributing factors.

Perhaps the most significant finding was that both systems failed to engage patients and families in the way experts recommend. Neither system had a robust process for ensuring that patients who suffered harm received psychological support, were involved in redesigning care, or were part of the education of future practitioners. Both systems also struggled to provide personalized feedback to the people who filed the reports. Without this feedback loop, the researchers noted, the motivation to keep reporting can fade, creating a cycle where fewer reports are filed, and less learning occurs.

The study concluded that the differences between the two systems were not a matter of one being better than the other, but rather a reflection of their different designs. The anonymous nature of the passive system made it strong on governance and broad reporting, while the active, research-based nature of the other system made it strong on detailed follow-up and patient input. The researchers argued that the chiropractic profession would be better served by using both approaches simultaneously rather than trying to choose one. By keeping both systems running, the profession could capture the broad, anonymous concerns of practitioners while also gathering the detailed, patient-centered data needed to understand specific outcomes. The goal is not to merge them into a single tool, but to ensure that the insights from both are shared across the profession, creating a more complete picture of patient safety than either could provide on its own.