Both in daily acute care and in the scaled acute care in case of disasters and crises, more attention is now given to improving the (anticipated) quality of care provided. Both types of care are operated as seamless care, in which the trauma centres and GHOR-offices (Medical assistance in case of accidents and disasters) function as the respective driving forces. Recently, NIVEL developed self-appraisal instruments for cooperation within the acute care sequence and for preparation for disasters within the care sequence for scaled health care. With the Health Care Institutions Act (WTZi) and the law on regional cooperative safety networks [Wet veiligheidsregio’s, WVR] in mind, there are calls to integrate the two care sequences. Performance indicators are still largely missing. Because of the introduction of out-of-hours GP centres problems are arising, especially regarding transfers and accessibility. Finally, there is a focus on the patient’s path through acute care and its sequence; this is a topic that will be tackled in more depth in the National Study of Illnesses and Care in the Primary Sector.

The regional consultation body on acute care [Regionaal Overleg Acute Zorg, ROAZ] in the VUmc region, Amsterdam wants to gain a better understanding of the performance of the acute care sequence in its region. Following up on developments within hospitals, it wants to set up a system for the reporting of incidents in acute care, specifically focused on possible organizational and logistical shortcomings. Such a system would offer the possibility of assessing the bottlenecks as care professionals themselves experience them. This concept has paramedic staff, Accident & Emergency staff, Air ambulance staff and GPs in mind. The term ‘incident’ refers to unintentional occurrences during the care process that might cause, have caused, or could still cause harm in the patient.

An understanding of incidents and the underlying organizational/logistical bottlenecks is also important to set priorities and identify initiatives for improvement. An additional effect of VIM projects [Veilig Incident Melden, or ‘reporting incidents safely’] is the change of culture that accompanies a greater openness about incidents.