Division of Primary Care, School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
NIHR Greater Manchester Patient Safety Translational Research Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, Greater Manchester, UK.
BMJ Qual Saf. 2021 Dec;30(12):961-976. doi: 10.1136/bmjqs-2020-011405. Epub 2020 Nov 10.
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.
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.
Primary care.
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).
The incidence of significant harm considered at least 'probably avoidable' and the nature of the safety incidents.
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.
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.
估计英格兰初级保健中可避免的严重伤害的发生率；描述和分类相关的患者安全事件，并提出减轻导致事件的可改善因素风险的建议。
回顾性病历审查。确定有严重健康问题的患者，并对伤害的可避免性和严重程度进行临床判断。确定并记录导致可避免伤害的因素。
初级保健。
13 名全科医生（GP）对来自英格兰三个地区的 12 个随机选择的普通实践中注册的 14407 名初级保健患者的样本进行了回顾性病历审查（总清单大小：92255 名患者）。
至少认为“可能可避免”的严重伤害发生率和安全事件的性质。
至少认为可能可避免的严重伤害发生率为每 100000 患者年 35.6（95%CI 23.3 至 48.0）（基于敏感性分析，每 100000 患者为 57.9，95%CI 42.2 至 73.7）。总体而言，检测到 74 例可避免的伤害，涉及 72 名患者。三种类型的事件占问题的 90%以上：诊断相关问题占 74 例（60.8%）原发性事件中的 45 例，其次是药物相关问题（n=19，25.7%）和延迟转诊（n=8，10.8%）。如果全科医生采取符合循证指南的行动，59 例（79.7%）严重伤害本可以更早（n=48）或预防（n=11）。
英格兰初级保健中可能存在大量可避免的严重伤害负担，其中诊断错误占大多数伤害。根据我们发现的促成因素，通过更有效地实施现有的信息技术、增强团队协调和沟通以及更大的个人和信息连续性护理，可以进行改进。
