Article Text

How safe is primary care? A systematic review
  1. Sukhmeet Singh Panesar1,
  2. Debra deSilva2,
  3. Andrew Carson-Stevens3,
  4. Kathrin M Cresswell4,
  5. Sarah Angostora Salvilla4,
  6. Sarah Patricia Slight5,
  7. Sundas Javad6,
  8. Gopalakrishnan Netuveli7,
  9. Itziar Larizgoitia8,
  10. Liam J Donaldson9,
  11. David W Bates10,
  12. Aziz Sheikh4
    1. 1Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
    2. 2The Evidence Centre, London, UK
    3. 3Primary Care Patient Safety Research Group, Cochrane Institute of Primary Care and Public Health; School of Nursing and Midwifery Studies, Cardiff University, Cardiff, UK
    4. 4Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
    5. 5Wolfson Research Institute, Durham University, Durham, UK
    6. 6MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK
    7. 7Institute for Health and Human Development, University of East London, London, UK
    8. 8Patient Safety Programme, WHO, Geneva, Switzerland
    9. 9Department of Surgery and Cancer, Imperial College London, London, UK
    10. 10Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
    1. Correspondence to Dr Sukhmeet Singh Panesar, Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas 77030, USA; sukhmeet.panesar{at}


    Importance Improving patient safety is at the forefront of policy and practice. While considerable progress has been made in understanding the frequency, causes and consequences of error in hospitals, less is known about the safety of primary care.

    Objective We investigated how often patient safety incidents occur in primary care and how often these were associated with patient harm.

    Evidence review We searched 18 databases and contacted international experts to identify published and unpublished studies available between 1 January 1980 and 31 July 2014. Patient safety incidents of any type were eligible. Eligible studies were critically appraised using validated instruments and data were descriptively and narratively synthesised.

    Findings Nine systematic reviews and 100 primary studies were included. Studies reported between <1 and 24 patient safety incidents per 100 consultations. The median from population-based record review studies was 2–3 incidents for every 100 consultations/records reviewed. It was estimated that around 4% of these incidents may be associated with severe harm, defined as significantly impacting on a patient's well-being, including long-term physical or psychological issues or death (range <1% to 44% of incidents). Incidents relating to diagnosis and prescribing were most likely to result in severe harm.

    Conclusions and relevance Millions of people throughout the world use primary care services on any given day. This review suggests that safety incidents are relatively common, but most do not result in serious harm that reaches the patient. Diagnostic and prescribing incidents are the most likely to result in avoidable harm.

    Systematic review registration This systematic review is registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD42012002304).

    • Patient safety
    • Primary care
    • Risk management

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