Background Patient identification is a central safety critical aspect of healthcare work. Most healthcare activities require identification of patients by healthcare staff, often in connection with the use of patient records. Indeed, the increasing reliance on electronic systems makes the correct matching of patients with their records a keystone for patient safety. Most research on patient identification has been carried out in hospital settings. The aim was to investigate the process of identification of patients and their records in the context of a primary healthcare clinic.

Method A qualitative field study was carried out at a Walk-In Centre in London (UK).

Results The identification of patients and their records was found to be a context-dependent process, both when formalised in procedures and when relying on informal practices. The authors discovered a range of formal and informal patient identifiers were used in this setting, depending on the task at hand. The theoretical lens of Pragmatics was applied to offer an explanation of this identification process.

Conclusions Context provides the cognitive scaffolding for a process of ‘suitably constrained guesswork’ about the identity of patients and their records. Implications for practice and for system design are discussed. Practitioners and technology designers should be aware of the risk for misidentifications inherent in this natural information processing activity.