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How safe is primary care? A systematic review

Lookup NU author(s): Professor Sarah Slight

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Abstract

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 Evidence review We searched 18 databases and contacted international experts to identify published and unpublished studies available between 1 January 1980 and 31 July 2014.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).


Publication metadata

Author(s): Panesar SS, Desilva D, Carson-Stevens A, Cresswell KM, Salvilla SA, Slight SP, Javad S, Netuveli G, Larizgoitia I, Donaldson LJ, Bates DW, Sheikh A

Publication type: Review

Publication status: Published

Journal: BMJ Quality and Safety

Year: 2016

Volume: 25

Issue: 7

Pages: 544-553

Print publication date: 01/07/2016

Online publication date: 17/06/2016

Acceptance date: 10/11/2015

ISSN (print): 2044-5415

ISSN (electronic): 2044-5423

Publisher: BMJ Publishing Group

URL: https://doi.org/10.1136/bmjqs-2015-004178

DOI: 10.1136/bmjqs-2015-004178


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