How safe is primary care? A systematic review

Abstract

Improving patient safety is at the forefront of policy and practice. While considerable progress has been made in understanding the frequency, causes and consequences of error in hospitals, less is known about the safety of primary care.We investigated how often patient safety incidents occur in primary care and how often these were associated with patient harm.We searched 18 databases and contacted international experts to identify published and unpublished studies available between 1 January 1980 and 31 July 2014. Patient safety incidents of any type were eligible. Eligible studies were critically appraised using validated instruments and data were descriptively and narratively synthesised.Nine systematic reviews and 100 primary studies were included. Studies reported between <1 and 24 patient safety incidents per 100 consultations. The median from population-based record review studies was 2-3 incidents for every 100 consultations/records reviewed. It was estimated that around 4% of these incidents may be associated with severe harm, defined as significantly impacting on a patients well-being, including long-term physical or psychological issues or death (range <1% to 44% of incidents). Incidents relating to diagnosis and prescribing were most likely to result in severe harm.Millions of people throughout the world use primary care services on any given day. This review suggests that safety incidents are relatively common, but most do not result in serious harm that reaches the patient. Diagnostic and prescribing incidents are the most likely to result in avoidable harm.This systematic review is registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD42012002304)

The Accuracy of Trigger Tools to Detect Preventable Adverse Events in Primary Care: A Systematic Review

“…A recent systematic review summarized the rate of AEs in the outpatient setting and identified an overall median AE rate of 4% (range, Ͻ1% to 24%) in over 100 primary studies. 25 A quality trigger tool should identify a significantly higher percentage of AEs than those that could be identified by random chart review. In addition, random chart review would undoubtedly miss relevant and preventable AEs.…”

“…We identified 5 systematic reviews that focused on safety events in the outpatient setting. 15,[23][24][25][26] However, none of these focused on the accuracy of tools in identifying pAEs.…”

Primary Care Providers’ Perspectives on Errors of Omission

“…Even the 2016 review above specifically excluded errors of omission, which it defined as those incidents occurring when there was a lapse in the quality of care. 2 Other researchers have conceptualized these acts of omission as "care omission," "tasks left undone," "missed care" or "gaps in care" [11][12][13][14][15][16][17][18] , and many refer to them as errors of omission. 21,22 Errors of omission outnumber errors of commission 2 to 1 19 ; yet, they are not well investigated or categorized, precluding their informing quality improvement strategies or designing safety systems to prevent these errors before they harm patients.…”

A Patient Safety Toolkit for Family Practices

“…2 However, patient safety incidents occur in 2% to 3% of all clinical encounters. 4 Family practice is thought of wrongly as inherently low risk, so safety is sometimes not considered a critical problem. 5 However, serious errors leading to morbidity and mortality occur regularly in family practice.…”

“…4 A major review of research between 2000 and 2010 found virtually no credible studies on how to improve safety in primary care. 9 To improve safety, one needs to be able to monitor and measure it.…”