TY - JOUR T1 - Diagnostic errors and harms in primary care: insights to action JF - BMJ Quality & Safety JO - BMJ Qual Saf DO - 10.1136/bmjqs-2020-012423 SP - bmjqs-2020-012423 AU - Greg Rubin AU - Ashley N D Meyer Y1 - 2021/05/31 UR - http://qualitysafety.bmj.com/content/early/2021/06/16/bmjqs-2020-012423.abstract N2 - In this issue we are presented with two novel and important studies in English primary care addressing the epidemiology of patient safety. The first study, by Reeves and colleagues, retrospectively reviewed 2057 randomly selected consultations in 21 general practices to identify missed diagnostic opportunities, in order to estimate their incidence, origins and potential harms.1 They conclude that diagnostic errors occur in up to 4% of consultations, are multifactorial, and that 40% of them have the potential to result in moderate or severe patient harm. The second study recruited 12 randomly selected general practices and reviewed the case notes of an ‘enhanced’ sample of 14 407 patients with significant health problems.2 In this second study, Avery and colleagues were interested in actual harms that could be considered avoidable, in order to estimate their incidence and to quantify and classify the context from which they arose. They identified 74 cases of avoidable significant harm, a rate of 36/100 000 patient years, with diagnosis problems accounting for the majority (61%).Although the field of patient safety research goes back to the 1980s, much of it was initially focused on specialist care and hospital settings, where rates of adverse events as high as 10% were reported.3 4 In contrast, studies in primary care found that rates of adverse events were much lower, but the potential for harm, notably from prescribing errors, was significant.5 This led to developments such as PINCER, a pharmacist-led intervention to reduce clinically important medication errors that has since been widely adopted … ER -