Patient safety in ambulatory care from the patient's perspective: a retrospective, representative telephone survey

Abstract

ObjectivesData on patient safety problems (PSPs) in ambulatory care are scarce. The aim of the study was to record the frequency, type, severity and point of origin of PSPs in ambulatory care in Germany.DesignRetrospective cross-sectional study.SettingComputer-assisted telephone interviews with randomly recruited citizens aged ≥40 years in Germany who were asked about their experiences with PSPs in ambulatory care.Participants10 037 citizens ≥40 years.MeasuresA new questionnaire was developed to record patient experiences with PSPs in ambulatory care. The study reported here targets patient experiences in the last 12 months. The questionnaire focuses on PSPs in seven areas of medical treatment: anamnesis/diagnostic procedures; medication; vaccination, injection, infusion; aftercare; outpatient surgery; office administration; other areas. For each PSP reported, detailed questions were asked about the specialist group concerned, and, on the most serious harm, the severity of the harm and its consequences. The target parameters are presented as proportions with 95% CIs.Results1422 of the respondents (14%) reported 2589 PSPs. The areas most frequently affected by PSPs were anamnesis/diagnostic procedures (61%) and medication (15%). General practitioners accounted for 44% of PSPs, orthopaedists for 15% and internists for 10%. 75% of PSPs were associated with harm, especially unnecessarily prolonged pain or deterioration of health; 35% of PSPs led to permanent harm. 804 PSPs (32%) prompted patients to see another doctor for additional treatment; 255 PSPs (10%) required inpatient treatment.ConclusionPSPs experienced by patients are widespread in ambulatory care in Germany. The study reveals in which areas of medical treatment efforts to prevent PSPs could make the greatest contribution to improving patient safety. It also demonstrates the valuable contribution of patient reports to the analysis of PSPs.

ASK ME!—Routine measurement of patient experience with patient safety in ambulatory care: A mixed-mode survey

“…The excellent response rate of this study indicates a high willingness of patients to provide feedback on their care if the response burden is acceptable, one factor for this being the length of the questionnaire [ 55 ]. Other surveys of patient experience with patient safety in ambulatory care using longer questionnaires yielded response rates of 12%, 18% and 64% in a telephone survey [ 3 ], a mailed survey [ 4 ] and a waiting room survey [ 6 ] respectively. Giles et al [ 27 ] point out that conducting on site surveys with long questionnaires face the challenge that the time to complete and return the questionnaire maybe longer than the waiting time and that completion may be interrupted by being called in to the doctor.…”

“…The included studies were heterogeneous in terms of definition and measurement of patient safety incidents which may partly explain the substantial range. However, when looking only at studies based on patient reports, the variation in observed rates remains considerable with 8 to 45% of participants reporting having experienced a patient safety problem [ 3 – 6 ].…”

“…These have focussed primarily on specific aspects of patient safety or outcomes of safety incidents in ambulatory care such as adverse drug events [ 26 ]. In recent years, some instruments have been developed that either measure patients’ experience with actual patient safety events [ 3 , 5 ], patients’ experience with error-producing or contributing factors [ 27 ] or both [ 28 ]. The questionnaire developed by Ricci-Cabello et al [ 28 ] consists of 71 items with the majority of items focussing on patients’ experience with safety problems and resulting harm and the remainder of items covering contributing factors in the areas of communication, participation, coordination and access.…”

“…Face validity testing showed good results and pilot participants confirmed ease of completion. Geraedts et al [ 3 ] designed a detailed tool recording patient experience with patient safety problems in ambulatory care for use in telephone interviews. It captures the occurrence of seven types of patient safety problems followed by questions on various details such as treatment area, frequency, presumed causes, type and severity of harm, recovery time and others.…”

How do patients respond to safety problems in ambulatory care? Results of a retrospective cross-sectional telephone survey

“…With a 1-year incidence of 14.2%, ambulatory care patients aged ≥40 years in Germany frequently report self-experienced patient safety problems (PSP). 1 Internationally, the state of research on the frequency of PSP in the ambulatory care sector is insufficient. According to a systematic literature review by Panesar et al 1-24 patient safety incidents (PSI) per 100 000 ambulatory consultations can be expected.…”