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Garzón González G, Alonso Safont T, Conejos Míquel D, Castelo Jurado M, Aguado Arroyo O, Jurado Balbuena JJ, Villanueva Sanz C, Zamarrón Fraile E, Luaces Gayán A, Cañada Dorado A, Martínez Patiño D, Magán Tapia P, Barberá Martín A, Toribio Vicente MJ, Drake Canela M, Mediavilla Herrera I. Validation of a Reduced Set of High-Performance Triggers for Identifying Patient Safety Incidents with Harm in Primary Care: TriggerPrim Project. J Patient Saf 2023; 19:508-516. [PMID: 37707868 PMCID: PMC10662617 DOI: 10.1097/pts.0000000000001161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
OBJECTIVE The aim of the study was to construct and validate a reduced set of high-performance triggers for identifying adverse events (AEs) via electronic medical records (EMRs) review in primary care (PC). METHODS This was a cross-sectional descriptive study for validating a diagnostic test. The study included all 262 PC centers of Madrid region (Spain). Patients were older than 18 years who attended their PC center over the last quarter of 2018. The randomized sample was n = 1797. Main measurements were as follows: ( a ) presence of each of 19 specific computer-identified triggers in the EMR and ( b ) occurrence of an AE. To collect data, EMR review was conducted by 3 doctor-nurse teams. Triggers with statistically significant odds ratios for identifying AEs were selected for the final set after adjusting for age and sex using logistic regression. RESULTS The sensitivity (SS) and specificity (SP) for the selected triggers were: ≥3 appointments in a week at the PC center (SS = 32.3% [95% confidence interval {CI}, 22.8%-41.8%]; SP = 92.8% [95% CI, 91.6%-94.0%]); hospital admission (SS = 19.4% [95% CI, 11.4%-27.4%]; SP = 97.2% [95% CI, 96.4%-98.0%]); hospital emergency department visit (SS = 31.2% [95% CI, 21.8%-40.6%]; SP = 90.8% [95% CI, 89.4%-92.2%]); major opioids prescription (SS = 2.2% [95% CI, 0.0%-5.2%]; SP = 99.8% [95% CI, 99.6%-100%]); and chronic benzodiazepine treatment in patients 75 years or older (SS = 14.0% [95% CI, 6.9%-21.1%]; SP = 95.5% [95% CI, 94.5%-96.5%]).The following values were obtained in the validation of this trigger set (the occurrence of at least one of these triggers in the EMR): SS = 60.2% (95% CI, 50.2%-70.1%), SP = 80.8% (95% CI, 78.8%-82.6%), positive predictive value = 14.6% (95% CI, 11.0%-18.1%), negative predictive value = 97.4% (95% CI, 96.5%-98.2%), positive likelihood ratio = 3.13 (95% CI, 2.3-4.2), and negative likelihood ratio = 0.49 (95% CI, 0.3-0.7). CONCLUSIONS The set containing the 5 selected triggers almost triples the efficiency of EMR review in detecting AEs. This suggests that this set is easily implementable and of great utility in risk-management practice.
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Affiliation(s)
- Gerardo Garzón González
- From the Quality and Safety Unit, Primary Care Management (Gerencia Asistencial de Atención Primaria), Madrid Health Service (SERMAS)
| | - Tamara Alonso Safont
- Information Systems Unit, Primary Care Management (Gerencia Asistencial de Atención Primaria), Madrid Health Service (SERMAS)
| | - Dolores Conejos Míquel
- From the Quality and Safety Unit, Primary Care Management (Gerencia Asistencial de Atención Primaria), Madrid Health Service (SERMAS)
| | - Marta Castelo Jurado
- “Federica Montseny” Primary Healthcare Centre (Centro de Salud Federica Montseny), Primary Care Management (Gerencia Asistencial de Atención Primaria), Madrid Health Service (SERMAS)
| | - Oscar Aguado Arroyo
- “Francia” Primary Healthcare Centre (Centro de Salud Francia), Primary Care Management (Gerencia Asistencial de Atención Primaria), Madrid Health Service (SERMAS)
| | - Juan José Jurado Balbuena
- “Alicante” Primary Healthcare Centre (Centro de Salud Alicante), Primary Care Management (Gerencia Asistencial de Atención Primaria), Madrid Health Service (SERMAS)
| | - Cristina Villanueva Sanz
- “Vicente Muzas” Primary Healthcare Centre (Centro de Salud Vicente Muzas), Primary Care Management (Gerencia Asistencial de Atención Primaria), Madrid Health Service (SERMAS)
| | - Ester Zamarrón Fraile
- “Baviera” Primary Healthcare Centre (Centro de Salud Baviera), Primary Care Management (Gerencia Asistencial de Atención Primaria), Madrid Health Service (SERMAS)
| | - Arancha Luaces Gayán
- “Torrelodones” Primary Healthcare Centre (Centro de Salud Torrelodones), Primary Care Management (Gerencia Asistencial de Atención Primaria), Madrid Health Service (SERMAS)
| | - Asunción Cañada Dorado
- From the Quality and Safety Unit, Primary Care Management (Gerencia Asistencial de Atención Primaria), Madrid Health Service (SERMAS)
| | - Dolores Martínez Patiño
- From the Quality and Safety Unit, Primary Care Management (Gerencia Asistencial de Atención Primaria), Madrid Health Service (SERMAS)
| | - Purificación Magán Tapia
- From the Quality and Safety Unit, Primary Care Management (Gerencia Asistencial de Atención Primaria), Madrid Health Service (SERMAS)
| | - Aurora Barberá Martín
- From the Quality and Safety Unit, Primary Care Management (Gerencia Asistencial de Atención Primaria), Madrid Health Service (SERMAS)
| | - María José Toribio Vicente
- “Gregorio Marañon” University General Hospital (Hospital General Universitario Gregorio Marañón), Madrid Health Service (SERMAS)
| | - Mercedes Drake Canela
- “Infanta Leonor” University Hospital (Hospital Universitario Infanta Leonor), Madrid Health Service (SERMAS), Madrid (Spain)
| | - Inmaculada Mediavilla Herrera
- From the Quality and Safety Unit, Primary Care Management (Gerencia Asistencial de Atención Primaria), Madrid Health Service (SERMAS)
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Hibbert PD, Molloy CJ, Schultz TJ, Carson-Stevens A, Braithwaite J. Comparing rates of adverse events detected in incident reporting and the Global Trigger Tool: a systematic review. Int J Qual Health Care 2023; 35:mzad056. [PMID: 37440353 PMCID: PMC10367579 DOI: 10.1093/intqhc/mzad056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 06/21/2023] [Accepted: 07/11/2023] [Indexed: 07/15/2023] Open
Abstract
Many hospitals continue to use incident reporting systems (IRSs) as their primary patient safety data source. The information IRSs collect on the frequency of harm to patients [adverse events (AEs)] is generally of poor quality, and some incident types (e.g. diagnostic errors) are under-reported. Other methods of collecting patient safety information using medical record review, such as the Global Trigger Tool (GTT), have been developed. The aim of this study was to undertake a systematic review to empirically quantify the gap between the percentage of AEs detected using the GTT to those that are also detected via IRSs. The review was conducted in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies published in English, which collected AE data using the GTT and IRSs, were included. In total, 14 studies met the inclusion criteria. All studies were undertaken in hospitals and were published between 2006 and 2022. The studies were conducted in six countries, mainly in the USA (nine studies). Studies reviewed 22 589 medical records using the GTT across 107 institutions finding 7166 AEs. The percentage of AEs detected using the GTT that were also detected in corresponding IRSs ranged from 0% to 37.4% with an average of 7.0% (SD 9.1; median 3.9 and IQR 5.2). Twelve of the fourteen studies found <10% of the AEs detected using the GTT were also found in corresponding IRSs. The >10-fold gap between the detection rates of the GTT and IRSs is strong evidence that the rate of AEs collected in IRSs in hospitals should not be used to measure or as a proxy for the level of safety of a hospital. IRSs should be recognized for their strengths which are to detect rare, serious, and new incident types and to enable analysis of contributing and contextual factors to develop preventive and corrective strategies. Health systems should use multiple patient safety data sources to prioritize interventions and promote a cycle of action and improvement based on data rather than merely just collecting and analysing information.
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Affiliation(s)
- Peter D Hibbert
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Macquarie Park, New South Wales 2109, Australia
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, GPO Box 2471, Adelaide, South Australia 5001, Australia
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia 5000, Australia
| | - Charlotte J Molloy
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Macquarie Park, New South Wales 2109, Australia
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, GPO Box 2471, Adelaide, South Australia 5001, Australia
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia 5000, Australia
| | - Timothy J Schultz
- Flinders Health and Medical Research Institute, Flinders University, Sturt Rd, Bedford Park 5042, South Australia, Australia
| | - Andrew Carson-Stevens
- PRIME Centre Wales & Division of Population Medicine, Cardiff University, Heath Park, Cardiff, Wales CF14 4XN, United Kingdom
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Macquarie Park, New South Wales 2109, Australia
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O'Dowd E, Lydon S, Lambe K, Rudland C, Hilton A, O'Connor P. Identifying hot spots for harm and blind spots across the care pathway from patient complaints about general practice. Fam Pract 2022; 39:579-585. [PMID: 34537832 PMCID: PMC9295605 DOI: 10.1093/fampra/cmab109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Healthcare complaints are underutilized for quality improvement in general practice. Systematic analysis of complaints has identified hot spots (areas across the care pathway where issues occur frequently) and blind spots (areas across the care pathway that cannot be observed by staff) in secondary care. The Healthcare Complaints Analysis Tool (HCAT) has been adapted to the HCAT(GP). AIMS This study aimed to: (i) assess whether the HCAT(GP) can systematically analyze complaints about general practice; and (ii) identify hot spots and blind spots in general practice. METHODS GP complaints were sampled. Complaints were coded with the HCAT(GP), classified by HCAT(GP) category (e.g. Safety, Environment, Listening), stage of care (e.g. accessing care, referral/follow-up), severity (e.g. low, medium, high), and harm (e.g. none, major). Descriptive statistics were run to identify discrete issues. A chi-square test of independence identified hot spots, and logistic regression was used for blind spots. RESULTS A total of 230 complaints, encompassing 432 issues (i.e. unique problems within complaints), were categorized. Relationship issues (e.g. problems with listening, communication, and patient rights) emerged most frequently (n = 174, 40%). Hot spots were identified in the consultation and the referral/follow-up stages (χ 2(5, n = 432) = 17.931, P < 0.05). A blind spot for multiple issues was identified, with the likelihood of harm increasing with number of issues (odds ratio = 2.02, confidence interval = 1.27-3.23, P < 0.05). CONCLUSIONS Complaints are valuable data for improving general practice. This study demonstrated that the HCAT(GP) can support the systematic analysis of general practice complaints, and identify hot spots and blind spots in care.
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Affiliation(s)
- Emily O'Dowd
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway, Ireland.,Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Galway, Ireland
| | - Sinéad Lydon
- Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Galway, Ireland.,School of Medicine, National University of Ireland Galway, Galway, Ireland
| | | | - Chris Rudland
- National Complaints Governance and Learning Team, Health Service Executive, Limerick, Ireland
| | - Aoife Hilton
- National Complaints Governance and Learning Team, Health Service Executive, Limerick, Ireland
| | - Paul O'Connor
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway, Ireland.,Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Galway, Ireland
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Klein DO, Rennenberg RJ, Koopmans RP, Prins MH. A Systematic Review of Methods for Medical Record Analysis to Detect Adverse Events in Hospitalized Patients. J Patient Saf 2021; 17:e1234-e1240. [PMID: 32168280 PMCID: PMC8612912 DOI: 10.1097/pts.0000000000000670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In this systematic review, we evaluate 2 of the most used trigger tools according to the criteria of the World Health Organization for evaluating methods. METHODS We searched Embase, PubMed, and Cochrane databases for studies (2000-2017). Studies were included if medical record review (MRR) was performed with either the Global Trigger Tool or the Harvard Medical Practice Study in a hospital population. Quality assessment was performed in duplicate. Fifty studies were included, and results were reported for every criterion separately. RESULTS Medical record review reveals more adverse events (AEs) than any other method. However, at the same time, it detects different AEs. The costs of an AE were on average €4296. Considerable efforts have been made worldwide in health care to improve safety and to reduce errors. These have resulted in some positive effects. The literature showed that MRR is focused on several domains of quality of care and seems suitable for both small and large cohorts. Furthermore, we found a moderate to substantial agreement for the presence of a trigger and a moderate to good agreement for the presence of an AE. CONCLUSIONS Medical record review with a trigger tool is a reasonably well-researched method for the evaluation of the medical records for AEs. However, looking at the World Health Organization criteria, much research is still lacking or of moderate quality. Especially for the cost of detecting AEs, valuable information is missing. Moreover, knowledge of how MRR changes quality and safety of care should be evaluated.
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Affiliation(s)
- Dorthe O. Klein
- From the Departments of Clinical Epidemiology and Medical Technology Assessment (KEMTA)
| | | | | | - Martin H. Prins
- Department of Epidemiology, School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
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Bratland SZ, Baste V, Steen K, Diaz E, Bondevik GT. Physician factors associated with medical errors in Norwegian primary care emergency services. Scand J Prim Health Care 2021; 39:429-437. [PMID: 34615440 PMCID: PMC8725954 DOI: 10.1080/02813432.2021.1973240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE The aim of this study was to examine the associations between characteristics of physicians working in primary care emergency units (PCEUs) and the outcome of assessments of the medical records. DESIGN Data from a previous case-control study was used to evaluate factors related to medical errors. SETTING Ten Norwegian PCEUs were included. SUBJECTS Physicians that had evoked a patient complaint, and a random sample of three physicians from the same PCEU and time period as the physician who had evoked a complaint. Recorded physician characteristics were: gender, seniority, citizenship at, and years after authorization as a physician, specialty in general practice, and workload at the PCEU. Main outcome measures: Assessments of the medical records: errors that may have led to harm, no medical error, or inconclusive. RESULTS In the complaint group 77 physicians were included, and in the random sample group 217. In the first group, 53.2% of the medical records were assessed as revealing medical errors. In the random sample group, this percentage was 3.2. In the complaint group the percentages for no-error and inconclusive for the female physicians were 30.8 and 15.4; and for the male physicians 9.8 and 27.3, p = 0.027. CONCLUSION In the group of complaints there was a higher percentage with no assessed medical error, and a lower percentage with inconclusive assessments of medical errors, among female physicians compared to their male colleagues. We found no other physician factors that were associated with assessed medical errors. Future research should focus on the underlying elements of these findings.Key pointsMedical errors are among the leading causes of death and they are essentially avoidable. Primary care emergency units are a vulnerable arena for committing medical errors.By assessing the medical records of a group of physicians who had evoked a complaint, no differences related to physician factors were revealed in the incidence of medical errors.In the group of female physicians, the proportion of no-errors, was higher, and the percentage of inconclusive medical records was lower than for their male colleagues.The Norwegian regulations on independent participation in PCEUs may have modulated these results.
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Affiliation(s)
- Svein Zander Bratland
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
- CONTACT Svein Zander Bratland National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Valborg Baste
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Knut Steen
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Esperanza Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Norway & Unit for Migration and Health, Norwegian Institute of Public Health Oslo, Bergen, Norway
| | - Gunnar Tschudi Bondevik
- Department of Global Public Health and Primary Care, University of Bergen & National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
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O'connor P, O'malley R, Lambe K, Byrne D, Lydon S. How safe is prehospital care? A systematic review. Int J Qual Health Care 2021; 33:6384516. [PMID: 34623421 PMCID: PMC8547145 DOI: 10.1093/intqhc/mzab138] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/23/2021] [Accepted: 09/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background As compared to other domains of healthcare, little is known about patient safety incidents (PSIs) in prehospital care. The aims of our systematic review were to identify how the prevalence and level of harm associated with PSIs in prehospital care are assessed; the frequency of PSIs in prehospital care; and the harm associated with PSIs in prehospital care. Method Searches were conducted of Medline, Web of Science, PsycInfo, CINAHL, Academic Search Complete and the grey literature. Reference lists of included studies and existing related reviews were also screened. English-language, peer-reviewed studies reporting data on number/frequency of PSIs and/or harm associated with PSIs were included. Two researchers independently extracted data from the studies and carried out a critical appraisal using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD). Results Of the 22 included papers, 16 (73%) used data from record reviews, and 6 (27%) from incident reports. The frequency of PSIs in prehospital care was found to be a median of 5.9 per 100 records/transports/patients. A higher prevalence of PSIs was identified within studies that used record review data (9.9 per 100 records/transports/patients) as compared to incident reports (0.3 per records/transports/patients). Across the studies that reported harm, a median of 15.6% of PSIs were found to result in harm. Studies that utilized record review data reported that a median of 6.5% of the PSIs resulted in harm. For data from incident reporting systems, a median of 54.6% of incidents were associated with harm. The mean QATSDD score was 25.6 (SD = 4.1, range = 16–34). Conclusions This systematic review gives direction as to how to advance methods for identifying PSIs in prehospital care and assessing the extent to which patients are harmed.
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Affiliation(s)
- Paul O'connor
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, 1 Distillery Road, Galway H91 TK33, Ireland.,Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Co. Galway H91 TK33, Ireland
| | - Roisin O'malley
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, 1 Distillery Road, Galway H91 TK33, Ireland.,Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Co. Galway H91 TK33, Ireland
| | - Kathryn Lambe
- Health Research Board, 67-72 Lower Mount Street, Dublin D02 H638, Ireland
| | - Dara Byrne
- Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Co. Galway H91 TK33, Ireland.,School of Medicine, National University of Ireland Galway, Co. Galway H91 TK33, Ireland
| | - SinÉad Lydon
- Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Co. Galway H91 TK33, Ireland.,School of Medicine, National University of Ireland Galway, Co. Galway H91 TK33, Ireland
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O'Connor P, Madden C, O'Dowd E, Byrne D, Lydon S. A meta-review of methods of measuring and monitoring safety in primary care. Int J Qual Health Care 2021; 33:6353929. [PMID: 34405231 PMCID: PMC8397923 DOI: 10.1093/intqhc/mzab117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/27/2021] [Accepted: 08/17/2021] [Indexed: 01/01/2023] Open
Abstract
Background A major barrier to safety improvement in primary care is a lack of safety data. The aims of this systematic meta-review (registration: CRD42021224367) were to identify systematic reviews of studies that examine methods of measuring and monitoring safety in primary care; classify the methods of measuring and monitoring safety in the included systematic reviews using the five safety domains of Vincent et al.’s framework and use this information to make recommendations for improving the measurement and monitoring of safety in primary care. Methods Four databases (Medline, Academic Search Complete, Web of Science and CINAHL) and the grey literature were screened in November 2020, with searches updated in January 2021. Systematic reviews were included if they addressed the measurement of patient safety in primary care and were published in English. Studies were assessed using the Critical Appraisal Skills Programme for systematic reviews. Results A total of 6904 papers were screened, with 13 systematic reviews included. A commonly reported method of measuring ‘past harm’ was through patient record review. The most frequent methods for assessing the ‘reliability of safety critical processes’ were checklists, observations and surveys of staff. Methods used to assess ‘sensitivity to operations’ included observation, staff surveys, interviews, focus groups, active monitoring and simulated patients. Safety climate surveys were a commonly used as an approach to assess ‘anticipation and preparedness’. A number of the reviews concluded that safety data could, and should, be used for ‘integration and learning’. The main limitation of the meta-review was that it was of systematic reviews only. Conclusions Many of the methods for measuring and monitoring safety are readily available, quick to administer, do not require external involvement and are inexpensive. However, there is still a need to improve the psychometric properties of many measures. Researchers must support the development of psychometrically sound safety measures that do not over burden primary care practitioners. Policymakers must consider how primary care practitioners can be supported to implement these measures.
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Affiliation(s)
- Paul O'Connor
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway H91 TK33, Ireland.,Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Co Galway H91 TK33, Ireland
| | - Caoimhe Madden
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway H91 TK33, Ireland.,Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Co Galway H91 TK33, Ireland
| | - Emily O'Dowd
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway H91 TK33, Ireland.,Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Co Galway H91 TK33, Ireland
| | - Dara Byrne
- Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Co Galway H91 TK33, Ireland.,School of Medicine, National University of Ireland Galway, Co Galway H91 TK33, Ireland
| | - SinÉad Lydon
- Discipline of General Practice, School of Medicine, National University of Ireland Galway, Galway H91 TK33, Ireland.,Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Co Galway H91 TK33, Ireland
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Gens-Barberà M, Hernández-Vidal N, Vidal-Esteve E, Mengíbar-García Y, Hospital-Guardiola I, Oya-Girona EM, Bejarano-Romero F, Castro-Muniain C, Satué-Gracia EM, Rey-Reñones C, Martín-Luján FM. Analysis of Patient Safety Incidents in Primary Care Reported in an Electronic Registry Application. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8941. [PMID: 34501530 PMCID: PMC8430626 DOI: 10.3390/ijerph18178941] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES (1) To describe the epidemiology of patient safety (PS) incidents registered in an electronic notification system in primary care (PC) health centres; (2) to define a risk map; and (3) to identify the critical areas where intervention is needed. DESIGN Descriptive analytical study of incidents reported from 1 January to 31 December 2018, on the TPSC Cloud™ platform (The Patient Safety Company) accessible from the corporate website (Intranet) of the regional public health service. SETTING 24 Catalan Institute of Health PC health centres of the Tarragona region (Spain). PARTICIPANTS Professionals from the PC health centres and a Patient Safety Functional Unit. MEASUREMENTS Data obtained from records voluntarily submitted to an electronic, standardised and anonymised form. Data recorded: healthcare unit, notifier, type of incident, risk matrix, causal and contributing factors, preventability, level of resolution and improvement actions. RESULTS A total of 1544 reports were reviewed and 1129 PS incidents were analysed: 25.0% of incidents did not reach the patient; 66.5% reached the patient without causing harm, and 8.5% caused adverse events. Nurses provided half of the reports (48.5%), while doctors reported more adverse events (70.8%; p < 0.01). Of the 96 adverse events, 46.9% only required observation, 34.4% caused temporary damage that required treatment, 13.5% required (or prolonged) hospitalization, and 5.2% caused severe permanent damage and/or a situation close to death. Notably, 99.2% were considered preventable. The main critical areas were: communication (27.8%), clinical-administrative management (25.1%), care delivery (23.5%) and medicines (18.4%); few incidents were related to diagnosis (3.6%). CONCLUSIONS PS incident notification applications are adequate for reporting incidents and adverse events associated with healthcare. Approximately 75% and 10% of incidents reach the patient and cause some damage, respectively, and most cases are considered preventable. Adequate and strengthened risk management of critical areas is required to improve PS.
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Affiliation(s)
- Montserrat Gens-Barberà
- Quality and Patient Safety Central Functional Unit, Gerència d’Atenció Primària Camp de Tarragona, Institut Català de la Salut, 43005 Tarragona, Spain; (N.H.-V.); (E.V.-E.); (Y.M.-G.); (I.H.-G.); (E.M.O.-G.); (F.B.-R.); (C.C.-M.)
| | - Núria Hernández-Vidal
- Quality and Patient Safety Central Functional Unit, Gerència d’Atenció Primària Camp de Tarragona, Institut Català de la Salut, 43005 Tarragona, Spain; (N.H.-V.); (E.V.-E.); (Y.M.-G.); (I.H.-G.); (E.M.O.-G.); (F.B.-R.); (C.C.-M.)
| | - Elisa Vidal-Esteve
- Quality and Patient Safety Central Functional Unit, Gerència d’Atenció Primària Camp de Tarragona, Institut Català de la Salut, 43005 Tarragona, Spain; (N.H.-V.); (E.V.-E.); (Y.M.-G.); (I.H.-G.); (E.M.O.-G.); (F.B.-R.); (C.C.-M.)
| | - Yolanda Mengíbar-García
- Quality and Patient Safety Central Functional Unit, Gerència d’Atenció Primària Camp de Tarragona, Institut Català de la Salut, 43005 Tarragona, Spain; (N.H.-V.); (E.V.-E.); (Y.M.-G.); (I.H.-G.); (E.M.O.-G.); (F.B.-R.); (C.C.-M.)
| | - Immaculada Hospital-Guardiola
- Quality and Patient Safety Central Functional Unit, Gerència d’Atenció Primària Camp de Tarragona, Institut Català de la Salut, 43005 Tarragona, Spain; (N.H.-V.); (E.V.-E.); (Y.M.-G.); (I.H.-G.); (E.M.O.-G.); (F.B.-R.); (C.C.-M.)
- Primary Health-Care Centre, Institut Català de la Salut, 43005 Tarragona, Spain
| | - Eva M. Oya-Girona
- Quality and Patient Safety Central Functional Unit, Gerència d’Atenció Primària Camp de Tarragona, Institut Català de la Salut, 43005 Tarragona, Spain; (N.H.-V.); (E.V.-E.); (Y.M.-G.); (I.H.-G.); (E.M.O.-G.); (F.B.-R.); (C.C.-M.)
- Primary Health-Care Centre, Institut Català de la Salut, 43005 Tarragona, Spain
| | - Ferran Bejarano-Romero
- Quality and Patient Safety Central Functional Unit, Gerència d’Atenció Primària Camp de Tarragona, Institut Català de la Salut, 43005 Tarragona, Spain; (N.H.-V.); (E.V.-E.); (Y.M.-G.); (I.H.-G.); (E.M.O.-G.); (F.B.-R.); (C.C.-M.)
- Pharmacy Unit, Gerència d’Atenció Primària Camp de Tarragona, Institut Català de la Salut, 43005 Tarragona, Spain
| | - Carles Castro-Muniain
- Quality and Patient Safety Central Functional Unit, Gerència d’Atenció Primària Camp de Tarragona, Institut Català de la Salut, 43005 Tarragona, Spain; (N.H.-V.); (E.V.-E.); (Y.M.-G.); (I.H.-G.); (E.M.O.-G.); (F.B.-R.); (C.C.-M.)
| | - Eva M. Satué-Gracia
- Research Support Unit Tarragona-Reus, Institut Universitari D’investigació en L’atenció Primària Jordi Gol, (IDIAP Jordi Gol), Institut Català de la Salut, 43202 Reus, Spain; (E.M.S.-G.); (C.R.-R.); (F.M.M.-L.)
| | - Cristina Rey-Reñones
- Research Support Unit Tarragona-Reus, Institut Universitari D’investigació en L’atenció Primària Jordi Gol, (IDIAP Jordi Gol), Institut Català de la Salut, 43202 Reus, Spain; (E.M.S.-G.); (C.R.-R.); (F.M.M.-L.)
- Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, 43201 Reus, Spain
| | - Francisco M. Martín-Luján
- Research Support Unit Tarragona-Reus, Institut Universitari D’investigació en L’atenció Primària Jordi Gol, (IDIAP Jordi Gol), Institut Català de la Salut, 43202 Reus, Spain; (E.M.S.-G.); (C.R.-R.); (F.M.M.-L.)
- Faculty of Medicine and Health Sciences, Universitat Rovira i Virgili, 43201 Reus, Spain
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Effectiveness of New Tools to Define an Up-to-Date Patient Safety Risk Map: A Primary Care Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168612. [PMID: 34444360 PMCID: PMC8392165 DOI: 10.3390/ijerph18168612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/28/2021] [Accepted: 08/10/2021] [Indexed: 11/16/2022]
Abstract
Background: Reducing incidents related to health care interventions to improve patient safety is a health policy priority. To strengthen a culture of safety, reporting incidents is essential. This study aims to define a patient safety risk map using the description and analysis of incidents within a primary care region with a prior patient safety improvement strategy organisationally developed and promoted. Methods: The study will be conducted in two phases: (1) a cross-sectional descriptive observational study to describe reported incidents; and (2) a quasi-experimental study to compare reported incidents. The study will take place in the Camp de Tarragona Primary Care Management (Catalan Institute of Health). In Phase 1, all reactive notifications collected within one year (2018) will be analysed; during Phase 2, all proactive notifications of the second and third weeks of June 2019 will be analysed. Adverse events will also be assessed. Phases 1 and 2 will use a digital platform and the proactive tool proSP to notify and analyse incidents related to patient safety. Expected Results: To obtain an up-to-date, primary care patient safety risk map to prioritise strategies that result in safer practices.
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Medication-related harm in New Zealand general practice: a retrospective records review. Br J Gen Pract 2021; 71:e626-e633. [PMID: 33798090 PMCID: PMC8252858 DOI: 10.3399/bjgp.2020.1126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/25/2021] [Indexed: 11/26/2022] Open
Abstract
Background The extent of medication-related harm in general practice is unknown. Aim To identify and describe all medication-related harm in electronic general practice records. The secondary aim was to investigate factors potentially associated with medication-related harm. Design and setting Retrospective cohort records review study in 44 randomly selected New Zealand general practices for the 3 years 2011–2013. Method Eight GPs reviewed 9076 randomly selected patient records. Medication-related harms were identified when the causal agent was prescribed in general practice. Harms were coded by type, preventability, and severity. The number and proportion of patients who experienced medication-related harm was calculated. Weighted logistic regression was used to identify factors associated with harm. Results In total, 976 of 9076 patients (10.8%) experienced 1762 medication-related harms over 3 years. After weighting, the incidence rate of all medication-related harms was 73.9 harms per 1000 patient–years, and the incidence of preventable, or potentially preventable, medication-related harms was 15.6 per 1000 patient–years. Most harms were minor (n = 1385/1762, 78.6%), but around one in five harms were moderate or severe (n = 373/1762, 21.2%); three patients died. Eighteen study patients were hospitalised; after weighting this correlates to a hospitalisation rate of 1.1 per 1000 patient–years. Increased age, number of consultations, and number of medications were associated with increased risk of medication-related harm. Cardiovascular medications, antineoplastic and immunomodulatory agents, and anticoagulants caused most harm by frequency and severity. Conclusion Medication-related harm in general practice is common. This study adds to the evidence about the risk posed by medication in the real world. Findings can be used to inform decision making in general practice.
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Leitch S, Dovey S, Cunningham W, Wallis K, Eggleton K, Lillis S, McMenamin A, Williamson M, Reith D, Samaranayaka A, Tilyard M. Epidemiology of healthcare harm in New Zealand general practice: a retrospective records review study. BMJ Open 2021; 11:e048316. [PMID: 34253671 PMCID: PMC8276280 DOI: 10.1136/bmjopen-2020-048316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To determine the epidemiology of healthcare harm observable in general practice records. DESIGN Retrospective cohort records review study. SETTING 72 general practice clinics were randomly selected from all 988 New Zealand clinics stratified by rurality and size; 44 clinics consented to participate. PARTICIPANTS 9076 patient records were randomly selected from participating clinics. INTERVENTION Eight general practitioners examined patient records (2011-2013) to identify harms, harm severity and preventability. Analyses were weighted to account for the stratified sampling design and generalise findings to all New Zealand patients. MAIN OUTCOME MEASURES Healthcare harm, severity and preventability. RESULTS Reviewers identified 2972 harms affecting 1505 patients aged 0-102 years. Most patients (82.0%, weighted) experienced no harm. The estimated incidence of harm was 123 per 1000 patient-years. Most harms (2160; 72.7%, 72.4% weighted) were minor, 661 (22.2%, 22.8% weighted) were moderate, and 135 (4.5%, 4.4% weighted) severe. Eleven patients died, five following a preventable harm. Of the non-fatal harms, 2411 (81.6%, 79.4% weighted) were considered not preventable. Increasing age and number of consultations were associated with increased odds of harm. Compared with patients aged ≤49 years, patients aged 50-69 had an OR of 1.77 (95% CI 1.61 to 1.94), ≥70 years OR 3.23 (95% CI 2.37 to 4.41). Compared with patients with ≤3 consultations, patients with 4-12 consultations had an OR of 7.14 (95% CI 5.21 to 9.79); ≥13 consultations OR 30.06 (95% CI 21.70 to 41.63). CONCLUSIONS Strategic balancing of healthcare risks and benefits may improve patient safety but will not necessarily eliminate harms, which often arise from standard care. Reducing harms considered 'not preventable' remains a laudable challenge.
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Affiliation(s)
- Sharon Leitch
- General Practice and Rural Health, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Susan Dovey
- General Practice and Rural Health, Otago Medical School, University of Otago, Dunedin, New Zealand
| | | | - Katharine Wallis
- Primary Care Clinical Unit, University of Queensland, Brisbane, Queensland, Australia
| | - Kyle Eggleton
- General Practice and Primary Healthcare, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Steven Lillis
- Student Health, University of Waikato, Hamilton, New Zealand
| | | | - Martyn Williamson
- General Practice and Rural Health, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - David Reith
- Office of the Dean, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Ariyapala Samaranayaka
- Preventive and Social Medicine, Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Murray Tilyard
- General Practice and Rural Health, Otago Medical School, University of Otago, Dunedin, New Zealand
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12
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Continuous, risk-based, consultation peer review in out-of-hours general practice: a qualitative interview study of the benefits and limitations. Br J Gen Pract 2021; 71:e797-e805. [PMID: 33979302 PMCID: PMC8366781 DOI: 10.3399/bjgp.2021.0076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/26/2021] [Indexed: 12/21/2022] Open
Abstract
Background Systems to detect and minimise unwarranted variation in clinician practice are crucial to ensure increasingly multidisciplinary healthcare workforces are supported to practise to their full potential. Such systems are limited in English general practice settings, with implications for the efficiency and safety of care. Aim To evaluate the benefits and limitations of a continuous, risk-based, consultation peer-review system used for 10 years by an out-of-hours general practice service in Bristol, UK. Design and setting A qualitative study in South West England. Method Semi-structured interviews with intervention users (clinicians, peer reviewers, and clinical management), analysed by inductive thematic analysis and integrated into a programme theory. Results Twenty clinicians were interviewed between September 2018 and January 2019. Interviewees indicated that the intervention supported clinician learning through improved peer feedback, highlighting learning needs and validating practice. It was compared favourably with existing structures of ensuring clinician competence, supporting standardisation of supervision, clinical governance, and learning culture. These benefits were potentially limited by intervention factors such as differential feedback quality between clinician groups, the efficiency of methods to identify learning needs, and limitations of assessments based on written clinical notes. Contextual factors such as clinician experience, motivation, and organisational learning culture influenced the perception of the intervention as a support or a stressor. Conclusion The findings demonstrate the potential of continuous, risk-based, consultation peer review to support clinicians in an increasingly multidisciplinary general practice workforce to efficiently and safely practise to their full potential. The programme theory provides a theoretical basis to maximise the benefits and accommodate the potential limitations of this methodology
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13
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Harrison R, Jones B, Gardner P, Lawton R. Quality assessment with diverse studies (QuADS): an appraisal tool for methodological and reporting quality in systematic reviews of mixed- or multi-method studies. BMC Health Serv Res 2021; 21:144. [PMID: 33588842 PMCID: PMC7885606 DOI: 10.1186/s12913-021-06122-y] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 01/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In the context of the volume of mixed- and multi-methods studies in health services research, the present study sought to develop an appraisal tool to determine the methodological and reporting quality of such studies when included in systematic reviews. Evaluative evidence regarding the design and use of our existing Quality Assessment Tool for Studies with Diverse Designs (QATSDD) was synthesised to enhance and refine it for application across health services research. METHODS Secondary data were collected through a literature review of all articles identified using Google Scholar that had cited the QATSDD tool from its inception in 2012 to December 2019. First authors of all papers that had cited the QATSDD (n=197) were also invited to provide further evaluative data via a qualitative online survey. Evaluative findings from the survey and literature review were synthesised narratively and these data used to identify areas requiring refinement. The refined tool was subject to inter-rater reliability, face and content validity analyses. RESULTS Key limitations of the QATSDD tool identified related to a lack of clarity regarding scope of use of the tool and in the ease of application of criteria beyond experimental psychological research. The Quality Appraisal for Diverse Studies (QuADS) tool emerged as a revised tool to address the limitations of the QATSDD. The QuADS tool demonstrated substantial inter-rater reliability (k=0.66), face and content validity for application in systematic reviews with mixed, or multi-methods health services research. CONCLUSION Our findings highlight the perceived value of appraisal tools to determine the methodological and reporting quality of studies in reviews that include heterogeneous studies. The QuADS tool demonstrates strong reliability and ease of use for application to multi or mixed-methods health services research.
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Affiliation(s)
- Reema Harrison
- School of Population Health, UNSW Sydney, Sydney, Australia.
| | - Benjamin Jones
- School of Population Health, UNSW Sydney, Sydney, Australia
| | - Peter Gardner
- School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
| | - Rebecca Lawton
- Institute of Psychological Sciences, University of Leeds, Leeds, UK
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Carrillo I, Mira JJ, Astier-Peña MP, Pérez-Pérez P, Caro-Mendivelso J, Olivera G, Silvestre C, Mula A, Nuin MÁ, Aranaz-Andrés JM. [Avoidable adverse events in primary care. Retrospective cohort study to determine their frequency and severity]. Aten Primaria 2020; 52:705-711. [PMID: 32527565 PMCID: PMC8054289 DOI: 10.1016/j.aprim.2020.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/28/2020] [Accepted: 02/04/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine the frequency of avoidable adverse events (AAEs) in Primary Care (PC). DESIGN Retrospective cohort study. LOCATION Family medicine and paediatric clinics in Andalusia, Aragon, Castilla-La Mancha, Catalonia, Madrid, Navarre, and Valencia. PARTICIPANTS A review was performed on a designated sample of 2,397 medical records (95% confidence level and 2% accuracy). The sample was stratified by age group as regards the frequency of physician consultations and considering equal distribution of male and female patients. MAIN MEASUREMENTS Number and severity of identified AAEs from February 2018 to September 2019. RESULTS A total of 2,557 medical records were reviewed (1,928, 75.4% of adult patients, and 629, 24.6% paediatrics). A total of 182 (7.1%, 95% CI 6.1-8.1%) AAEs that affected 168 patients were identified, which included 7.6% (95% CI 6.4-8.8%) in adults and 5.7% (95% CI 3.9-7.5%) in paediatric patients. The number of AAEs in women was higher than in men (P = 0.006). The incidence of AAEs in boys and girls was similar (P = 0.3). Permanent damage was caused by AAEs in 6 (4.1%) adult patients. CONCLUSIONS Seeking formulas to increase patient safety in PC should remain a priority objective, particularly in female patients and in paediatrics. One in 24 AAEs causes serious and permanent damage in adults.
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Affiliation(s)
- Irene Carrillo
- Universidad Miguel Hernández de Elche, Elche, Alicante, España; Fundació per al Foment de la Investigació Sanitària i Biomèdica de la Comunitat Valenciana (FISABIO), Elche, Alicante, España
| | - José Joaquín Mira
- Universidad Miguel Hernández de Elche, Elche, Alicante, España; Centro de Salud Hospital Provincial-Pla, Departamento de Salud Alicante - Sant Joan D'Alacant, San Juan, Alicante, España.
| | | | - Pastora Pérez-Pérez
- Observatorio para la Seguridad del Paciente, Agencia de Calidad Sanitaria de Andalucía, Sevilla, España
| | | | - Guadalupe Olivera
- Hospital Clínico San Carlos, Servicio Madrileño de Salud, Madrid, España
| | - Carmen Silvestre
- Servicio de Efectividad y Seguridad Asistencial, Servicio Navarro de Salud-Osasunbidea, Pamplona, España
| | - Aurora Mula
- Fundació per al Foment de la Investigació Sanitària i Biomèdica de la Comunitat Valenciana (FISABIO), Elche, Alicante, España
| | | | - Jesús M Aranaz-Andrés
- Servicio de Medicina Preventiva y Salud Pública, Hospital Universitario Ramón y Cajal, Madrid, España; Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, España
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Bratland SZ, Baste V, Steen K, Diaz E, Gjelstad S, Bondevik GT. Physician factors associated with increased risk for complaints in primary care emergency services: a case - control study. BMC FAMILY PRACTICE 2020; 21:201. [PMID: 32977768 PMCID: PMC7519491 DOI: 10.1186/s12875-020-01272-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 09/15/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Patient safety incidents defined as any unintended or unexpected incident that could have or were judged to have led to patient harm, are reported as relatively common. In this study patient complaints have been used as an indicator to uncover the occurrence of patient safety incidents in primary care emergency units (PCEUs) in Norway. METHODS Ten PCEUs in major cities and rural parts of Norway participated. These units cover one third of the Norwegian population. A case-control design was applied. The case was the physician that evoked a complaint. The controls were three randomly chosen physicians from the same PCEU as the physician having evoked the complaint. The following variables regarding the physicians were chosen: gender, citizenship at, and years after authorization as physician, and specialty in general practice. The magnitude of patient contact was defined as the workload at the PCEU. The physicians' characteristics and workload were extracted from the medical records from the fourteen-day period prior to the consultation that elicited the complaint. The rest of the variables were then obtained from the Norwegian physician position register. Logistic regression was used to estimate odds ratio for complaints both unadjusted and adjusted for the independent variables. The data were analyzed using SPSS (Version25) and STATA. RESULTS A total of 78 cases and 217 controls were included during 18 months (September 1st 2015 till March 1st 2017). The risk of evoking a complaint was significantly higher for physicians without specialty in general practice, and lower for those with medium low and medium high workload compared to physicians with no duty during the fourteen-day period prior to the index consultation. The limited strength of the study did not make it possible to assess any correlation between workload and the other variables (physician's gender, seniority and citizenship at time of authorization). CONCLUSIONS Continuous medical training and achieving the specialty in general practice were decisively associated with a reduced risk for complaints in primary care emergency services. Future research should focus on elements promoting quality of care such as continuing education, duty rosters and other structural and organizational factors.
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Affiliation(s)
- Svein Zander Bratland
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Kalfarveien 31, N-5018, Bergen, Norway.
| | - Valborg Baste
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Kalfarveien 31, N-5018, Bergen, Norway
| | - Knut Steen
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Kalfarveien 31, N-5018, Bergen, Norway
| | - Esperanza Diaz
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, N-5018, Bergen, Norway.,Unit for Migration and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Svein Gjelstad
- Department of General Practice, University of Oslo, Kirkeveien 166, Fredrik Holsts hus, N-0450, Oslo, Norway
| | - Gunnar Tschudi Bondevik
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Kalfarveien 31, N-5018, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, N-5018, Bergen, Norway
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Holderried F, Herrmann-Werner A, Mahling M, Holderried M, Riessen R, Zipfel S, Celebi N. Electronic charts do not facilitate the recognition of patient hazards by advanced medical students: A randomized controlled study. PLoS One 2020; 15:e0230522. [PMID: 32214333 PMCID: PMC7098576 DOI: 10.1371/journal.pone.0230522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 03/02/2020] [Indexed: 11/19/2022] Open
Abstract
Chart review is an important tool to identify patient hazards. Most advanced medical students perform poorly during chart review but can learn how to identify patient hazards context-independently. Many hospitals have implemented electronic health records, which enhance patient safety but also pose challenges. We investigated whether electronic charts impair advanced medical students’ recognition of patient hazards compared with traditional paper charts. Fifth-year medical students were randomized into two equal groups. Both groups attended a lecture on patient hazards and a training session on handling electronic health records. One group reviewed an electronic chart with 12 standardized patient hazards and then reviewed another case in a paper chart; the other group reviewed the charts in reverse order. The two case scenarios (diabetes and gastrointestinal bleeding) were used as the first and second case equally often. After each case, the students were briefed about the patient safety hazards. In total, 78.5% of the students handed in their notes for evaluation. Two blinded raters independently assessed the number of patient hazards addressed in the students’ notes. For the diabetes case, the students identified a median of 4.0 hazards [25%–75% quantiles (Q25–Q75): 2.0–5.5] in the electronic chart and 5.0 hazards (Q25–Q75: 3.0–6.75) in the paper chart (equivalence testing, p = 0.005). For the gastrointestinal bleeding case, the students identified a median of 5.0 hazards (Q25–Q75: 4.0–6.0) in the electronic chart and 5.0 hazards (Q25–Q75: 3.0–6.0) in the paper chart (equivalence testing, p < 0.001). We detected no improvement between the first case [median 5.0 (Q25–Q75: 3.0–6.0)] and second case [median, 5.0 (Q25–Q75: 3.0–6.0); p < 0.001, test for equivalence]. Electronic charts do not seem to facilitate advanced medical students’ recognition of patient hazards during chart review and may impair expertise formation.
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Affiliation(s)
- Friederike Holderried
- Department of Anaesthesiology, University Hospital Tübingen, Tübingen, Baden-Württemberg, Germany
| | - Anne Herrmann-Werner
- Department of Internal Medicine VI, Psychosomatic Medicine, University Hospital Tübingen, Baden-Württemberg, Tübingen, Germany
| | - Moritz Mahling
- Department of Diabetology, Endocrinology, Nephrology, Section of Nephrology and Hypertension, University Hospital Tübingen, Tübingen, Baden-Württemberg, Germany
- * E-mail:
| | - Martin Holderried
- Department of Quality Management, Medical and Business Development, University Hospital of Tübingen, Tübingen, Baden-Württemberg, Germany
| | - Reimer Riessen
- Department of Internal Medicine VIII, Intensive Care Unit, University Hospital Tübingen, Tübingen, Baden-Württemberg, Germany
| | - Stephan Zipfel
- Department of Internal Medicine VI, Psychosomatic Medicine, University Hospital Tübingen, Baden-Württemberg, Tübingen, Germany
| | - Nora Celebi
- PHV Dialysis Center Waiblingen, Waiblingen, Germany
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Madden C, Lydon S, Cupples ME, Hart ND, Curran C, Murphy AW, O’Connor P. Safety in primary care (SAP-C): a randomised, controlled feasibility study in two different healthcare systems. BMC FAMILY PRACTICE 2019; 20:22. [PMID: 30700257 PMCID: PMC6352328 DOI: 10.1186/s12875-019-0909-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 01/16/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patient safety research is conducted predominantly in hospital settings, with a dearth of insight from primary care, despite suggestions that 2.2% of primary care consultations result in a patient safety incident. This study aimed to assess the feasibility of an intervention intended to improve patient safety in general practice. METHODS A randomised controlled feasibility study was conducted with general practices in the Republic of Ireland (N = 9) and Northern Ireland (N = 2), randomly assigned to the intervention (N = 5) or control (N = 6) group. The nine-month intervention consisted of: 1) repeated safety climate (SC) measurement (using GP-SafeQuest questionnaire) and feedback (comparative anonymised practice-level SC data), and 2) patient record reviews using a specialised trigger tool to identify instances of undetected patient harm. For control practices, SC was measured at baseline and study end only. The intervention's perceived usefulness and feasibility were explored via an end-of-study questionnaire and semi-structured interviews. RESULTS Thirteen practices were invited; 11 participated; 10 completed the study. At baseline, 84.8% of intervention practice staff (39/46) and 77.8% (42/54) of control practice staff completed the SC questionnaire; at the study terminus, 78.3% (36/46) of intervention practice staff and 68.5% (37/54) of control practice staff did so. Changes in SC scores, indicating improvement, were observed among the intervention practices but not in the control group. The trigger tool was applied to 188 patient records; patient safety incidents of varying severity were detected in 19.1% (36/188). Overall, 59% of intervention practice team members completed the end-of-study questionnaire, with the majority in both healthcare systems responding positively about the intervention. Interviews (N = 9) identified the intervention's usefulness in informing practice management and patient safety issues, time as a barrier to its use, and the value of group discussion of feedback. CONCLUSION This feasibility study suggests that a definitive randomised controlled trial of the intervention is warranted. Our findings suggest that the intervention is feasible, useful, and sustainable. Practices were willing to be recruited into the study, response and retention rates were acceptable, and there is possible evidence of a positive effect of the intervention. TRIAL REGISTRATION The trial registration number is: ISRCTN11426121 (retrospectively registered 12th June 2018).
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Affiliation(s)
- Caoimhe Madden
- Department of General Practice, School of Medicine, National University of Ireland, Galway, Galway, Ireland
- HRB Primary Care Clinical Trial Network Ireland, National University of Ireland, Galway, Galway, Ireland
| | - Sinéad Lydon
- School of Medicine, National University of Ireland, Galway, Galway, Ireland
- Irish Centre for Applied Patient Safety and Simulation, NUI Galway, Galway, Ireland
| | - Margaret E. Cupples
- HRB Primary Care Clinical Trial Network Ireland, National University of Ireland, Galway, Galway, Ireland
- UK Clinical Research Collaboration Centre of Excellence for Public Health, Queen’s University Belfast, Grosvenor Road, Belfast, BT12 6BJ UK
- Centre for Public Health, School of Medicine, Dentristry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Nigel D. Hart
- Centre for Medical Education, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, UK
| | - Ciara Curran
- Department of General Practice, School of Medicine, National University of Ireland, Galway, Galway, Ireland
- Irish Centre for Applied Patient Safety and Simulation, NUI Galway, Galway, Ireland
| | - Andrew W. Murphy
- Department of General Practice, School of Medicine, National University of Ireland, Galway, Galway, Ireland
- HRB Primary Care Clinical Trial Network Ireland, National University of Ireland, Galway, Galway, Ireland
| | - Paul O’Connor
- Department of General Practice, School of Medicine, National University of Ireland, Galway, Galway, Ireland
- HRB Primary Care Clinical Trial Network Ireland, National University of Ireland, Galway, Galway, Ireland
- Irish Centre for Applied Patient Safety and Simulation, NUI Galway, Galway, Ireland
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