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A preliminary taxonomy of medical errors in family practice
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  1. S M Dovey1,
  2. D S Meyers1,
  3. R L Phillips, Jr1,
  4. L A Green1,
  5. G E Fryer1,
  6. J M Galliher2,
  7. J Kappus2,
  8. P Grob3
  1. 1The Robert Graham Center: Policy Studies in Family Practice and Primary Care, Washington, DC 20036, USA
  2. 2The National Network for Family Practice and Primary Care Research, The American Academy of Family Physicians, Leawood, KS 66211-2672, USA
  3. 3Department of Postgraduate General Practice, The Postgraduate Deanery for Kent, East Surrey and Sussex, Guildford, Surrey GU2 5RF, UK
  1. Correspondence to:
 Dr S Dovey, The Robert Graham Center: Policy Studies in Family Practice and Primary Care, 2023 Massachusetts Ave NW, Washington, DC 20036, USA;
 sdovey{at}aafp.org

Abstract

Objective: To develop a preliminary taxonomy of primary care medical errors.

Design: Qualitative analysis to identify categories of error reported during a randomized controlled trial of computer and paper reporting methods.

Setting: The National Network for Family Practice and Primary Care Research.

Participants: Family physicians.

Main outcome measures: Medical error category, context, and consequence.

Results: Forty two physicians made 344 reports: 284 (82.6%) arose from healthcare systems dysfunction; 46 (13.4%) were errors due to gaps in knowledge or skills; and 14 (4.1%) were reports of adverse events, not errors. The main subcategories were: administrative failures (102; 30.9% of errors), investigation failures (82; 24.8%), treatment delivery lapses (76; 23.0%), miscommunication (19; 5.8%), payment systems problems (4; 1.2%), error in the execution of a clinical task (19; 5.8%), wrong treatment decision (14; 4.2%), and wrong diagnosis (13; 3.9%). Most reports were of errors that were recognized and occurred in reporters' practices. Affected patients ranged in age from 8 months to 100 years, were of both sexes, and represented all major US ethnic groups. Almost half the reports were of events which had adverse consequences. Ten errors resulted in patients being admitted to hospital and one patient died.

Conclusions: This medical error taxonomy, developed from self-reports of errors observed by family physicians during their routine clinical practice, emphasizes problems in healthcare processes and acknowledges medical errors arising from shortfalls in clinical knowledge and skills. Patient safety strategies with most effect in primary care settings need to be broader than the current focus on medication errors.

  • family practice
  • medical errors
  • primary care
  • taxonomy
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