Nature and type of patient-reported safety incidents in primary care: cross-sectional survey of patients from Australia and England

Abstract

BackgroundPatient engagement in safety has shown positive effects in preventing or reducing adverse events and potential safety risks. Capturing and utilising patient-reported safety incident data can be used for service learning and improvement.ObjectiveThe aim of this study was to characterise the nature of patient-reported safety incidents in primary care.DesignSecondary analysis of two cross sectional studies.ParticipantsAdult patients from Australian and English primary care settings.MeasuresPatients’ self-reported experiences of safety incidents were captured using the validated Primary Care Patient Measure of Safety questionnaire. Qualitative responses to survey items were analysed and categorised using the Primary Care Patient Safety Classification System. The frequency and type of safety incidents, contributory factors, and patient and system level outcomes are presented.ResultsA total of 1329 patients (n=490, England; n=839, Australia) completed the questionnaire. Overall, 5.3% (n=69) of patients reported a safety incident over the preceding 12 months. The most common incident types were administration incidents (n=27, 31%) (mainly delays in accessing a physician) and incidents involving diagnosis and assessment (n=16, 18.4%). Organisation of care accounted for 27.6% (n=29) of the contributory factors identified in the safety incidents. Staff factors (n=13, 12.4%) was the second most commonly reported contributory factor. Where an outcome could be determined, patient inconvenience (n=24, 28.6%) and clinical harm (n=21, 25%) (psychological distress and unpleasant experience) were the most frequent.ConclusionsThe nature and outcomes of patient-reported incidents differ markedly from those identified in studies of staff-reported incidents. The findings from this study emphasise the importance of capturing patient-reported safety incidents in the primary care setting. The patient perspective can complement existing sources of safety intelligence with the potential for service improvement.

Is primary care a patient-safe setting? Prevalence, severity, nature, and causes of adverse events: numerous and mostly avoidable

“…Despite employing a restrictive definition, this study found that 7% of the detected AEs were severe, which is similar to or higher than that reported in other studies [ 9 , 10 , 13 , 15 ], although the definitions of AEs varied among them. This estimation implies that, in every thousand consultations attended in PC, severe harm will be caused to a patient due to health care.…”

“…The majority of studies on AEs are conducted via medical record review [ 2 ] in a hospital setting [ 3–5 ]. Several studies in a primary care (PC) setting can be found, which employed diverse methods: reporting systems [ 6–8 ] that detected incidence values of <0.1%; interviewing health professionals or patients [ 9 , 10 ], with occurrence rates of AEs between 0.05% and 5%; observational studies on consultations [ 11 ], which estimated a prevalence of AEs of 1.1%; and few studies that reviewed clinical records for the assessment of only specific types of AEs or patients at high risk [ 12–14 ], which reported rates of AEs between 0.1% and 1% [ 15–17 ]. To our knowledge, only one study in PC has investigated the global occurrence of AEs via clinical records review, including all types of AEs in the general population, although the sample was not large and the calculations were imprecise [ 18 ].…”

‘Safety is about partnership’: Safety through the lens of patients and caregivers

“…Patient involvement in reporting safety issues offers perspectives that tend to differ from the incidents reported by providers, providing a fuller picture of contributors to unsafe care. Hernan et al 29 examined such differences in patient-versus provider-reported incidents in their patient safety study in primary care settings in England and Australia.…”

El Plan de acción mundial para la seguridad del paciente 2021-2030: identificando acciones para una atención primaria más segura

“…Algunas estimaciones dicen que hasta cuatro de cada 10 pacientes sufren daños en atención primaria/ambulatoria 11 . Los errores más graves en este nivel asistencial son los relacionados con el diagnóstico, la prescripción y el uso de medicamentos 12 . Aunque los problemas acontecidos en este entorno son menos visibles que los ocurridos en el hospital, no se debe ignorar su impacto ante el gran volumen de pacientes atendidos en el primer nivel asistencial 13 .…”