International perspectives on eliciting and characterising patient safety incidents in general practice

Talk Code: 
Emma Wallace, Sudeh Cheraghi-Sohi, Katharine Wallis/Susan Dovey

Symposium Summary

Aim To explore different methods and data sources aiming to elicit patient safety incidents in general practice, namely examining patient complaints and using General Practitioner (GP) electronic medical record review to characterize diagnostic error and patient harm.  Symposium Content Brief introduction and rationale of symposium  This symposium will present primary care research conducted in three different countries (Ireland, New Zealand and UK) with differing healthcare systems. Three oral presentations will focus on varying aspects of patient safety namely, characteristing patient complaints in out of hours general practice and identifying diagnostic error and patient harm through GP electronic health record review. A moderated group discussion will follow where this theme will be explored in more detail. Patient safety is a critical issue for general practice researchers, clinicians and patients and this research is timely and relevant. Presenting research conducted in different countries will facilitate discussion of the commonalties and differences across countries in approaching this issue.  Format of symposium Brief introduction (5 minutes)  Three oral presentations; each presentation will be 15 minutes with 5 minutes for questions/clarifications. (60 minutes) Moderated group discussion (25 minutes) Intended audience Primary care researchers, GPs, other clinicians working in primary care

Presentation 1 - Characterising patient complaints in out of hours Irish general practice: a retrospective cohort study

Dr Emma Wallace HRB Centre for Primary Care Research, Royal College of Surgeons (RCSI), Dublin, Ireland


Studies examining the epidemiology of complaints in out of hours general practice internationally are limited. This retrospective cohort study examined patient complaints to an out of hours service provider in Dublin over a five-year period (2011-2016). The service consists of nurse-led telephone triage and GP consultations for patients with urgent problems. Anonymised complaint files were reviewed independently by two academic GPs, with inter-rater reliability and a kappa statistic calculated. A modified version of the Healthcare Complaints Analysis Tool was utilised to code and categorise complaints. Patient level of harm was rated according to the UK National Reporting and Learning System.

Presentation 2 - Estimating the Burden of Missed Diagnostic Opportunities in General Practice in the United Kingdom: A retrospective record review study

Dr Sudeh Cheraghi-Sohi, NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK


Data on incidence, types and contributory factors for diagnostic errors in primary care are only now emerging. To date there are no large-scale epidemiological studies in the United Kingdom (UK) to reliably quantify diagnostic error and associated harm in primary care. Diagnostic error rates vary according to how ‘error’ is defined but one suggested hallmark is clear evidence of a missed opportunity (MDO) to make a correct or timely diagnosis. 2070 records were jointly reviewed by 2 or more GP reviewers and a kappa statistic calculated. The rate and associated harms of identified errors and their causes will be presented.

Presentation 3 - Epidemiology of patient harms in general practice in New Zealand: a retrospective records review study

Dr Katharine Wallis Department of General Practice & Primary Health Care, The University of Auckland, Auckland, New Zealand, and

Prof Susan Dovey, Professor of Public Health and Epidemiology

RCSI Bahrain


The epidemiology of patient harms in general practice is not well understood. In this records review study, eight GP reviewers reviewed the health records of 9000 randomly selected patients for 2011-2013 to describe the type, frequency, severity and preventability of patient harm (not error). Harm was defined as the physical or emotional negative consequences or financial costs to patients directly arising from health care beyond the usual consequences of care and not attributable to the patient’s condition. All harms were categorized for severity and preventability and then coded centrally.

Submitted by: 
Emma Wallace