Patient safety in Dutch primary care: a study protocol

Abstract

BackgroundInsight into the frequency and seriousness of potentially unsafe situations may be the first step towards improving patient safety. Most patient safety attention has been paid to patient safety in hospitals. However, in many countries, patients receive most of their healthcare in primary care settings. There is little concrete information about patient safety in primary care in the Netherlands. The overall aim of this study was to provide insight into the current patient safety issues in Dutch general practices, out-of-hours primary care centres, general dental practices, midwifery practices, and allied healthcare practices. The objectives of this study are: to determine the frequency, type, impact, and causes of incidents found in the records of primary care patients; to determine the type, impact, and causes of incidents reported by Dutch healthcare professionals; and to provide insight into patient safety management in primary care practices.Design and methodsThe study consists of three parts: a retrospective patient record study of 1,000 records per practice type was conducted to determine the frequency, type, impact, and causes of incidents found in the records of primary care patients (objective one); a prospective component concerns an incident-reporting study in each of the participating practices, during two successive weeks, to determine the type, impact, and causes of incidents reported by Dutch healthcare professionals (objective two); to provide insight into patient safety management in Dutch primary care practices (objective three), we surveyed organizational and cultural items relating to patient safety. We analysed the incidents found in the retrospective patient record study and the prospective incident-reporting study by type of incident, causes (Eindhoven Classification Model), actual harm (severity-of-outcome domain of the International Taxonomy of Medical Errors in Primary Care), and probability of severe harm or death.DiscussionTo estimate the frequency of incidents was difficult. Much depended on the accuracy of the patient records and the professionals' consensus about which types of adverse events have to be recognized as incidents.

Patient safety in primary health care: a systematic review

“…There was a balance in the yearly distribution of the articles' publication: four in 2007 9,10,11,12 , six in 2008 13,14,15,16,17,18 , three in 2009 19,20,21 , ten in 2010 22,23,24,25,26,27,28,29,30,31 , six in 2011 32,33,34,35,36,37 and four in 2012 38,39,40,41 (Table 2).…”

“…The study population consisted of physicians and other health professionals 9,10,13,14,15,16,19,20,22,24,25,28,30,32,33,34,35,36,39,40 , patients and families 26 , and health professionals and patients and families 11,21,23,27,29,31,41 , while in some studies the study population was not described in complete detail 17,22,38 (Table 2).…”

“…Other studies used a combination of methods for data sources: incident reporting systems, direct observation, and focus groups 35 ; incident reporting systems, direct observation, and interviews 11 ; direct observation with audio recording 29 ; direct observation and expert consensus 36 ; incident reporting systems, patient file review, and interviews 41 ; incident reporting systems and patient file review 21 ; incident reporting systems, interviews, and questionnaires 30 ; expert consensus, questionnaires for patients, and focus groups 31 ; incident reporting systems, patient file review, and questionnaires 41 (Table 2). Six studies 12,17,21,30,31,41 used a combination of data sources. Reporting system were the most frequent data source: 15 studies (45%) 9,11,12,13,14,15,18,19,21,30,32,35,37,38,41 .…”

“…All the studies were descriptive. Nine studies were retrospective 9,13,14,15,18,19,32,37,38 , 14 prospective 10,16,20,22, 23,24,25,26,27,28,33,34,39,40 , and ten cross-sectional 11,12,17,21,29,30,31,35,36,41 .…”

“…Six studies 12,17,21,30,31,41 used a combination of data sources. Reporting system were the most frequent data source: 15 studies (45%) 9,11,12,13,14,15,18,19,21,30,32,35,37,38,41 . The definition of adverse events differed, while the great majority of studies did not present a definition for these events.…”