Understanding the Nature and Frequency of Avoidable Harm in Primary Care

Conference:

SAPC ASM 2019 - Exeter

Talk Code:

P2.46

Presenter:

Anthony Avery

Co-authors:

Anthony Avery, Christina Sheehan, Brian Bell, Sarah Armstrong, Darren Ashcroft, Matthew Boyd, Antony Chuter, Alison Cooper, Ailsa Donnelly, Adrian Edwards, Huw Evans, Stuart Helland, Joanne Lymn, Rajnikant Mehta, Sarah Rodgers, Aziz Sheikh, Pam Smith, Huw Williams, Stephen Campbell, Andrew Stevens

Author institutions:

University of Nottingham, University of Manchester, Cardiff University, University of Edinburgh

Problem

Most patient safety research has focused on hospital settings (secondary care) where there is now considerable appreciation of the causes and frequency of medical errors, and the resulting harm to patients. There have been few large-scale robust studies that have investigated the frequency, nature and causes of avoidable harm in family medicine/primary care. There is a need for such studies in order to identify strategies for improving patient safety. The aims of our study was to estimate the incidence of avoidable significant harm in primary care in England and describe and classify the patient safety incidents that result in avoidable significant harm.

Approach

We conducted a retrospective cohort study of electronic clinical records with independent family practitioners who were trained to undertake case note reviews. The family practitioners reviewed patient records and recorded any incidences of avoidable significant harm over a 12 month period. All patients (n=92,255) registered at 12 general practices across England between 1 April 2015 and 31 March 2016 (89,779 patient years) were eligible for inclusion in the study. The main outcomes were the incidence, per 100,000 patient years, of significant harm judged to be at least possibly avoidable or probably avoidable.

Findings

The incidence of avoidable significant harm considered at least possibly avoidable was 56.8 (95% CI: 41.2 to 72.4) per 100,000 patient years; the incidence of avoidable significant harm considered at least probably avoidable was 35.6 (95% CI: 23.3 to 48.0) per 100,000 patient years. From 55 cases of at least possibly avoidable significant harm, the most important primary incidents were missed diagnosis (20.0%), delayed diagnosis (27.3%), delayed referral (10.9%) and medication error (23.6%).

Consequences

Applying our findings to the English population of 56 million means that each year we would expect to see between 19.800 and 32.200 cases of probably avoidable significant harm. To prevent these harms the greatest attention needs to be paid to addressing the ameliorable factors associated with missed diagnosis, delayed diagnosis, delayed referral, and medication error.

Submitted by:

Brian Bell

Funding acknowledgement:

This report is based on independent research commissioned and funded by the NIHR Policy Research Programme (‘Understanding the Nature and Frequency of Avoidable Harm in Primary Care’, Ref: PR-R11-0914-11001).