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Tip of the iceberg: patient safety incidents in primary care
  1. Urmimala Sarkar
  1. Correspondence to Associate Professor Urmimala Sarkar, Division of General Internal Medicine, University of California, San Francisco, Center for Vulnerable Populations, San Francisco General Hospital, 1001 Potrero Avenue, Building 10, 3rd floor, San Francisco CA 94110, USA; Urmimala.Sarkar{at}

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Primary care in the US model is fraught with safety hazards. Visits are brief and infrequent, patients are largely self-managing, often with multiple comorbid conditions, the extent of healthcare teams varies widely, and the fragmentation of health systems and lack of interoperability among electronic health records (EHRs) means that primary care providers may not have timely, accurate data about patients.1 Despite these multiple vulnerabilities, significant gaps remain in our understanding of the safety of primary care.2–4

The patient safety movement began in acute-care settings, where adverse events resulting from medical care are more immediately apparent. Even though primary care is the cornerstone of healthcare delivery, relatively less is known about the epidemiology of adverse events in primary care settings.5 In an effort to address this gap, Panesar et al6 conducted a systematic review of patient safety incidents in primary care.

This paper makes a major contribution to the field by providing an overview of the burden of patient safety incidents in primary care. They found that patient safety incidents are slightly less common in primary care, around 2%–3% of visits, compared with approximately 10% of hospitalisations.7–9 Given how much larger and healthier the populations using primary care are compared with hospitalised patients, the frequency of safety incidents in primary care is staggeringly high. Fortunately, only a small proportion of …

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