An Analysis of the Implementation and Use of (Critical) Incident Reporting Systems ((C)IRSs) in German Hospitals: A Retrospective Cross-Sectional Study from 2017 to 2022

<b>Background:</b> Incident reporting systems (IRSs) have become a central instrument for improving patient safety in hospitals. In Germany, hospitals are legally required to implement internal IRSs, while participation in cross-institutional IRSs is voluntary. <b>Methods</b>: In a retrospective, descriptive cross-sectional study, the structured quality reports of all German hospitals from 2017 to 2022 (2598-2408 hospitals (2017-2022)) were analysed. The participation of hospitals in internal and cross-institutional IRSs was examined, as was the frequency of training and evaluations of incident reports. <b>Results:</b> The rate of participation in internal IRSs increased from 94.0% in 2017 to 96.6% in 2019 and remained stable at 96.0% in 2022. About 85% of hospitals conducted internal evaluations of the incident reports, with monthly evaluations being the most common (33.9%). Training on how to use IRSs was mostly provided on an ad hoc basis (41.6% in 2022), with regular training being less common. Participation in cross-institutional IRSs increased significantly from 44.5% in 2017 to 55% in 2019 and remained stable until 2022. Participation in hospital IRSs showed significant increases, while specialised systems exhibited lower participation rates. <b>Conclusions</b>: Internal IRSs have been established in German hospitals; however, there is still room for improvement in conducting regular training sessions and evaluations. Although participation in cross-institutional IRSs has increased, it remains fragmented. Further centralisation and standardisation could enhance efficiency and contribute to an improvement in patient safety.