An international taxonomy for errors in general practice: a pilot study

Abstract

Objectives: To develop an international taxonomy describing errors reported by general practitioners in Australia and five other countries. Design and setting: GPs in Australia, Canada, the Netherlands, New Zealand, the United Kingdom and the United States reported errors in an observational pilot study. Anonymous reports were electronically transferred to a central database. Data were analysed by Australian and international investigators. Participants: Non‐randomly selected GPs: 23 in Australia, and between 8 and 20 in the other participating countries. Main outcome measures: Error categories, and consequences. Results: In Australia, 17 doctors reported 134 errors, compared with 301 reports by 63 doctors in the other five countries. The final taxonomy was a five‐level system encompassing 171 error types. The first‐level classification was “process errors” and “knowledge and skills errors”. The proportion of errors in each of these primary groups was similar in Australia (79% process; 21% knowledge and skills) and the other countries (80% process; 20% knowledge and skills). Patient harm was reported in 32% of reports from Australia and 30% from other countries. Participants considered the harm “very serious” in 9% of Australian reports and 3% of other countries' reports. Conclusions: This pilot study indicates that errors are likely to affect primary care patients in similar ways in countries with similar primary healthcare systems. Further comparative studies are required to improve our understanding of general practice error differences between Australia and other countries.

Patient safety events reported in general practice: a taxonomy

“…Application of the taxonomy to the TAPS data shows that the majority of reports contained a single patient safety event, and the majority of events related to the processes of providing healthcare rather than deficiencies in knowledge and skills of health professionals, as postulated in previous work with non-representative samples 7 9 11 12…”

“…The investigators coded the set of 433 reports using the pilot taxonomy,12 and the last 132 reports (approximately a quarter) were coded using the TAPS taxonomy. The agreement among the three coders at each level of both the pilot and TAPS taxonomies, with corresponding κ scores, are shown in table 2.…”

“…Our proposed taxonomy builds on pilot work which has at its primary level a causative classification,11 12 with subcategories based on grouping of like themes, and then addition of detail with descriptive categories in the style of a domain-specific taxonomy. Application of the taxonomy to the TAPS data shows that the majority of reports contained a single patient safety event, and the majority of events related to the processes of providing healthcare rather than deficiencies in knowledge and skills of health professionals, as postulated in previous work with non-representative samples 7 9 11 12…”

“…Three GPs from the investigating team (MAM, SS and CBW) classified each report using an existing pilot taxonomy,12 and results were compared to obtain a baseline measure of reproducibility. Reports containing more than one event were given multiple codes in chronological order of events.…”

Levels of agreement on the grading, analysis and reporting of significant events by general practitioners: a cross-sectional study

“…reviewing the literature on common “significant” events and/or “errors” in international family practice;7 8 10 20 – 22…”