Primary Care Providers’ Perspectives on Errors of Omission

Abstract

Background: Despite recent focus on patient safety in primary care, little attention has been paid to errors of omission, which represent significant gaps in care and threaten patient safety in primary care but are not well studied or categorized. The purpose of this study was to develop a typology of errors of omission from the perspectives of primary care providers (PCPs) and understand what factors within practices lead to or prevent these omissions.Methods: A qualitative descriptive design was used to collect data from 26 PCPs, both physicians and nurse practitioners, from the New York State through individual interviews. One researcher conducted all interviews, which were audiotaped, transcribed verbatim, and analyzed in ATLAS.ti, Berlin by 3 researchers using content analysis. They immersed themselves into data, read transcripts independently, and conducted inductive coding. The final codes were linked to each other to develop the typology of errors of omission and the themes. Data saturation was reached at the 26th interview.Results: PCPs reported that omitting patient teaching, patient followup, emotional support, and addressing mental health needs were the main categories of errors of omission. PCPs perceived that time constraints, unplanned patient visits and emergencies, and administrative burden led to these gaps in care. They emphasized that organizational support and infrastructure, effective teamwork and communication, and preparation for the patient encounter were important safeguards to prevent errors of omission within their practices.Discussion: Errors of omission are common in primary care and could threaten patient safety. Efforts to eliminate them should focus on strengthening organizational attributes of practices, improving teamwork and communication, and assigning manageable workload to PCPs.Conclusions: Practice and policy change is necessary to address gaps in care and prevent them before they result in patient harm. (J Am Board Fam Med 2017;30:733-742.)

A systematic review of the impact of ‘missed care’ in primary, community and nursing home settings

“…The Errors of Care Omission Survey is associated with three papers (Poghosyan et al, 2017; Poghosyan, Norful, Ghaffari, et al, 2019; Poghosyan, Norful, Liu, et al, 2019). The origins of the Errors of Care Omission Survey date from 2017 when Poghosyan and colleagues sought to develop a typology of errors of omission from the perspectives of primary care providers.…”

“…In the case of studies, where analysis did not distinguish between nursing and care delivered by a primary care physician (e.g. Poghosyan et al, 2017), a study would be included on the basis of explicit reference to nursing care. The population was adult patients in primary care or community care settings (including nursing homes) in comparable health service contexts: Australia, Canada, Ireland, New Zealand, the UK and the USA.…”

Characteristics of recovery from near misses in primary health care nursing: A Prospective descriptive study

“…Another type of near miss, which has received little attention in the literature, is that of the omission of necessary actions, despite the fact that both commission and omission acts can be considered errors or, if recovered, near miss events (Poghosyan et al., 2017). Although this problem is relatively infrequent, it was identified in our study; therefore, omissions should be prevented with adequate workload and staffing levels or specific education (Härkänen et al., 2019).…”

Whose role is preventive healthcare in the veterinary practice?

“…Yet, unfortunately, when roles are not clearly deined, errors of omission can easily occur when a task fails to be recognised as part of a speciic role resulting in compromised patient care. 11,12 Changing practice culture Recognising that the client (with their pet) is at the centre of the veterinary practice may involve a change in practice culture in what is traditionally a hierarchical establishment with the veterinary surgeon at the head, directing the required treatment. 13 With RVNs becoming a profession in their own right, being accountable for their actions and subject to a disciplinary system, it is time that roles are re-evaluated within the practice and the workload delegated to team members with relevant skills and expertise.…”