A Systematic Review of Measurement Tools for the Proactive Assessment of Patient Safety in General Practice

Abstract

Background. Primary care physicians have reported a difficulty in understanding how best to measure and improve patient safety in their practices. Objectives. To identify measures of patient safety suitable for use in primary care and provide guidance on proactively monitoring and measuring safety. Methods. Searches were conducted using Medline, Embase, CINAHL and PsycInfo in February 2016. Studies that utilised a measure assessing levels of, or attitudes towards, patient safety in primary care were considered for inclusion. Only studies describing tools focused on the proactive assessment of safety were reviewed. Two independent reviewers extracted data from articles and applied the Quality Assessment Tool for Studies with Diverse Designs. Results. 2,800 studies were screened, of which 56 were included. The majority of studies had utilised healthcare staff survey or interviews to assess patient safety (N=34), followed by patient chart audit (N=14), or use of a practice assessment checklist (N=7). Survey or interview of patients, active monitoring systems, and simulated patients were used with less frequency. Conclusions and relevance. A lack of appropriate measurement tools has been suggested to limit the ability to monitor patient safety in primary care and to improve patient care. There is no evident "best" method of measuring patient safety in primary care. However, many of the measures are readily available, quick to administer, do not require external involvement, and Manchester Patient Safety Framework Used in four studies 23-26 PC SafeQuest Used in three studies 27-29 SCOPE questionnaire Used in three studies 25,30,31 Medical Office Survey on Patient Safety Culture Used in three studies 32-34 Frankfurt Patient Safety Climate Questionnaire Used in three studies 14,35,36 Hospital Survey on Patient Safety Culture Used in two studies 37,38 Perceived hazard questionnaire Used in two studies 39,40 Survey tool/interview protocol used in only one study Used in 11 studies 13,14,41-49 Studies utilising patient chart audit methodologies In total, 14 studies (see Tables 1 and 3; for detailed study descriptions, see Table 2 in Online Supplementary Material 2) used existing patients' charts in order to identify previously undetected patient safety incidents.

Developing and evaluating a tool to measure general practice productivity: a multimethod study

“…They found 21 articles, including a total of 182 safety measures, and classified these into six dimensions: (1) medication management, (2) sentinel events, (3) care co-ordination, (4) procedures and treatment, (5) laboratory testing and monitoring and (6) facility structures/resources. However, the types of measures were not dissimilar to those found by Lydon et al 47 An earlier review by Ricci-Cabello et al 49 undertook a similar exercise and reached similar conclusions (albeit on a smaller scale). Therefore, the inclusion of patient safety within a broader index will pose a significant challenge.…”

“…However, patient safety within primary care is not something that is measured in any standard form. Lydon et al 47 conducted a systematic review of measurement tools for the proactive assessment of patient safety in general practice. Of the 56 studies identified by this systematic review, 34 used surveys/ interviews, 14 used a form of patient chart audit and 7 used practice assessment checklists; there were a handful of other tools that were not repeated across studies.…”

A systematic review of 7 years of research on entrustable professional activities in graduate medical education, 2011–2018

“…Scores on the QATSDD can range from 0 to 42 (qualitative and quantitative studies) or 48 (mixed‐methods studies). This assessment tool has been shown to produce good agreement and has been used in a number of different reviews pertaining to health services and medical education research . The QATSDD was applied to studies within both categories by two researchers independently and any disagreements were resolved through discussion.…”

A systematic review of patient complaints about general practice

“…This tool was considered appropriate as the studies included in this review were heterogeneous in design. The QATSDD is a 16-item scale developed for use by health service researchers, which has been used successfully in other systematic reviews (25)(26)(27). Each QATSDD item is scored on a scale ranging from 0 (e.g., 'no mention at all') to 3 (e.g., 'detailed description of each stage of the data collection procedure'), with a maximum possible score of 42 for qualitative or quantitative studies, and 48 for mixed method studies.…”