RT Journal Article
SR Electronic
T1 Incidence, nature and causes of avoidable significant harm in primary care in England: retrospective case note review
JF BMJ Quality & Safety
JO BMJ Qual Saf
FD BMJ Publishing Group Ltd
SP 961
OP 976
DO 10.1136/bmjqs-2020-011405
VO 30
IS 12
A1 Avery, Anthony J
A1 Sheehan, Christina
A1 Bell, Brian
A1 Armstrong, Sarah
A1 Ashcroft, Darren M
A1 Boyd, Matthew J
A1 Chuter, Antony
A1 Cooper, Alison
A1 Donnelly, Ailsa
A1 Edwards, Adrian
A1 Evans, Huw Prosser
A1 Hellard, Stuart
A1 Lymn, Joanne
A1 Mehta, Rajnikant
A1 Rodgers, Sarah
A1 Sheikh, Aziz
A1 Smith, Pam
A1 Williams, Huw
A1 Campbell, Stephen M
A1 Carson-Stevens, Andrew
YR 2021
UL http://qualitysafety.bmj.com/content/30/12/961.abstract
AB Objective To estimate the incidence of avoidable significant harm in primary care in England; describe and classify the associated patient safety incidents and generate suggestions to mitigate risks of ameliorable factors contributing to the incidents.Design Retrospective case note review. Patients with significant health problems were identified and clinical judgements were made on avoidability and severity of harm. Factors contributing to avoidable harm were identified and recorded.Setting Primary care.Participants Thirteen general practitioners (GPs) undertook a retrospective case note review of a sample of 14 407 primary care patients registered with 12 randomly selected general practices from three regions in England (total list size: 92 255 patients).Main outcome measures The incidence of significant harm considered at least ‘probably avoidable’ and the nature of the safety incidents.Results The rate of significant harm considered at least probably avoidable was 35.6 (95% CI 23.3 to 48.0) per 100 000 patient-years (57.9, 95% CI 42.2 to 73.7, per 100 000 based on a sensitivity analysis). Overall, 74 cases of avoidable harm were detected, involving 72 patients. Three types of incident accounted for more than 90% of the problems: problems with diagnosis accounted for 45/74 (60.8%) primary incidents, followed by medication-related problems (n=19, 25.7%) and delayed referrals (n=8, 10.8%). In 59 (79.7%) cases, the significant harm could have been identified sooner (n=48) or prevented (n=11) if the GP had taken actions aligned with evidence-based guidelines.Conclusion There is likely to be a substantial burden of avoidable significant harm attributable to primary care in England with diagnostic error accounting for most harms. Based on the contributory factors we found, improvements could be made through more effective implementation of existing information technology, enhanced team coordination and communication, and greater personal and informational continuity of care.Data are available upon reasonable request. Anonymised summary data extracted from patient records regarding the avoidable harms detected in this study will be available upon reasonable request.