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Summary Objectives The objectives of this study were (i) to identify levels of awareness and understanding of a patient safety incident (PSI) reporting system by members of the British Chiropractic Association (BCA); (ii) to identify BCA members’ attitudes to the reporting of PSIs; (iii) to identify possible barriers to incident reporting and the use of the Chiropractic Reporting and Learning System (CRLS) by BCA members. Design Qualitative, semi-structured interviews. Setting Chiropractic practices in Dorset, Hampshire and Wiltshire, and the Anglo-European College of Chiropractic (AECC) outpatient clinic. Subjects Seven chiropractors (four female, three male) with between 6 months’ and 27 years’ practice experience. Methods Interviews were recorded and subsequently transcribed verbatim. Data were analysed using thematic analysis. Results All participants were aware of the CRLS prior to being contacted and were positive in their attitudes towards it. The interviewees considered the CRLS as a tool that could help the profession to achieve accountability and openness, and improve patient safety. Reasons identified for under-reporting included fear of retribution, being too busy and insufficient clarity on what to report. Conclusions The CRLS was considered to be of benefit to the profession. However, until there is greater clarity of the purpose and role of the CRLS, the system will probably remain under-utilised. Strategies should be implemented to improve the reporting of PSIs to the CRLS, including extensive education of the profession. In particular, chiropractors need to understand that without personal initiative on a local as well as national level, improving patient safety by learning from reporting may be difficult to achieve.

Summary Objective To design and test a reporting format for patient safety incidents (PSIs) related to chiropractic practice. Design A pilot study of adverse event monitoring. Setting Field chiropractic practice and the teaching clinic of the Anglo-European College of Chiropractic. Subjects Members of the British Chiropractic Association and final year clinical students. Methods Following design of a reporting format, chiropractors and/or final year clinical students responded by completing a form and submitting this to a central collection point for analysis. Results Forms were received from seven field practitioners and from 63 students providing information on a number of PSIs. The low number of field practitioners responding prevented any summative analysis and the results are therefore presented individually. With reference to the final year clinical students, the majority of PSIs were associated with misuse of therapeutic equipment (32%) and the treatment intervention itself (31%). Conclusions Gathering information on PSIs using this format was shown to be both feasible and fit for purpose. Further work is planned to widen access and to facilitate and promote the attributes for an informed safety culture for the chiropractic profession.

Background context: Neck pain is a leading cause of morbidity and health care utilisation worldwide, and spinal manipulative therapy (SMT) has become an increasingly popular therapeutic approach for the treatment of mechanical neck disorders and headache. Within the UK, the chiropractic profession is one of the main providers for SMT, however, the frequency with which neck manipulations are carried out is unknown. Purpose: To establish the number of annual patient visits at which at least one cervical manipulation treatment had been performed by practising members of the British (BCA) and Scottish (SCA) chiropractic associations. Methods: A self-administered questionnaire was sent to 399 registered chiropractors chosen from the membership databases of the BCA and SCA. The chiropractors were asked to enter the total number of patient visits in which at least one cervical manipulation had been administered during a predetermined study week. Results: A total of 291 questionnaires were returned (response rate 72.9%). Based on 281 usable data files, one BCA or SCA chiropractor performs on average a minimum of 40 cervical spine manipulations each week. Assuming that the average BCA/SCA chiropractor works for 49 weeks per year, this equates to 1975 treatment visits per year at which at least one cervical spine manipulation is administered. At the time the sample was taken for this study, a combined total of 1139 chiropractors were registered on the BCA and SCA databases. By extrapolation, the combined membership of the BCA and SCA, would therefore perform a minimum of 2,250,664 cervical spine manipulations or adjustments in 1 year. Conclusions: This study, for the first time, established that, for 2003, the average BCA and SCA chiropractor administered a weekly minimum of 40 cervical spine manipulations and that, on an annual basis, a conservative estimate of 2.25 million cervical spine manipulations are carried out.

Recent changes in the National Health Service (NHS) in the UK have included a major push towards improving the quality of patient care and the safety of the offered services under the mantle of clinical governance. The various elements that constitute clinical governance are, in the main, just as relevant to the chiropractic profession as they are to the NHS. Some of these elements, such as “clinical risk management” and “openness and accountability” may perhaps be more challenging to adopt by organisations and their members, as changes in organisational culture are required. These issues are discussed and an opinion on how they may relate to the chiropractic profession is offered.