Question: What will be confirmed as an area of future research?
Evidence: This work has applied a multiscale graph partitioning algorithm (Markov Stability) to extract content-based clusters of documents from a textual dataset of healthcare safety incident reports in an unsupervised manner at different levels of resolution. The method uses paragraph vectors to represent the records and obtains an ensuing similarity graph of documents constructed from their content. The framework brings the advantage of multi-resolution algorithms capable of capturing clusters without imposing a priori their number or structure. Since different levels of resolution of the clustering can be found to be relevant, the practitioner can choose the level of description and detail to suit the requirements of a specific task.
Our a posteriori analysis evaluating the similarity against the hand-coded categories and the intrinsic topic coherence of the clusters showed that the method performed well in recovering meaningful categories. The clusters of content capture topics of medical practice, thus providing complementary information to the externally imposed classification categories. Our analysis shows that some of the most relevant and persistent communities emerge because of their highly homogeneous medical content, although they are not easily mapped to the standardised external categories. This is apparent in the medically-based content clusters associated with Labour ward, Pressure ulcer, Chemotherapy, Radiotherapy, among others, which exemplify the alternative groupings that emerge from free text content.
The categories in the top level (Level 1) of the pre-defined classification hierarchy are highly diverse in size (as shown by their number of assigned records), with large groups such as `Patient accident', `Medication', `Clinical assessment', `Documentation', `Admissions/Transfer' or `Infrastructure' alongside small, specific groups such as `Aggressive behaviour', `Patient abuse', `Self-harm' or `Infection control'. Our multi-scale partitioning finds corresponding groups in content across different levels of resolution, providing additional subcategories with medical detail within some of the large categories (as shown in Fig. 4 and S1 ). An area of future research will be to confirm if the categories found by our analysis are consistent with a second level in the hierarchy of external categories (Level 2, around 100 categories) that is used less consistently in hospital settings. The use of content-driven classification of reports could also be important within current efforts by the World Health Organisation (WHO) under the framework for the International Classification for Patient Safety (ICPS) BIBREF48 to establish a set of conceptual categories to monitor, analyse and interpret information to improve patient care.
One of the advantages of a free text analytical approach is the provision, in a timely manner, of an intelligible description of incident report categories derived directly from the rich description in the 'words' of the reporter themselves. The insight from analysing the free text entry of the person reporting could play a valuable role and add rich information than would have otherwise been obtained from the existing approach of pre-defined classes. Not only could this improve the current state of play where much of the free text of these reports goes unused, but it avoids the fallacy of assigning incidents to a pre-defined category that, through a lack of granularity, can miss an important opportunity for feedback and learning. The nuanced information and classifications extracted from free text analysis thus suggest a complementary axis to existing approaches to characterise patient safety incident reports.
Currently, local incident reporting system are used by hospitals to submit reports to the NRLS and require risk managers to improve data quality of reports, due to errors or uncertainty in categorisation from reporters, before submission. The application of free text analytical approaches, like the one we have presented here, has the potential to free up risk managers time from labour-intensive tasks of classification and correction by human operators, instead for quality improvement activities derived from the intelligence of the data itself. Additionally, the method allows for the discovery of emerging topics or classes of incidents directly from the data when such events do not fit the pre-assigned categories by using projection techniques alongside methods for anomaly and innovation detection.
In ongoing work, we are currently examining the use of our characterisation of incident reports to enable comparisons across healthcare organisations and also to monitor their change over time. This part of ongoing research requires the quantification of in-class text similarities and to dynamically manage the embedding of the reports through updates and recalculation of the vector embedding. Improvements in the process of robust graph construction are also part of our future work. Detecting anomalies in the data to decide whether newer topic clusters should be created, or providing online classification suggestions to users based on the text they input are some of the improvements we aim to add in the future to aid with decision support and data collection, and to potentially help fine-tune some of the predefined categories of the external classification.
An area of future research will be to confirm if the categories found by our analysis are consistent with a second level in the hierarchy of external categories (Level 2, around 100 categories) that  used less consistently in hospital settings.
Answer: An area of future research will be to confirm if the categories found by their analysis are consistent with a second level in the hierarchy of external categories (Level 2, around 100 categories) that  used less consistently in hospital settings.