Nature of patient-reported safety concerns in the UK during the early phase of the COVID-19 pandemic: preliminary analysis of a cross-sectional survey

Problem

COVID-19 has led to profound changes in the way in which primary care, and other forms of healthcare, is delivered across the UK. Shifting resources to support virus cases has compromised individual healthcare for non- COVID related illnesses leading to potential safety concerns experienced by patients. Patients can play a critical role in identifying safety incidents, and frequently report concerns not captured by typical incident reporting systems or medical records. Therefore, it is essential we understand the nature of these concerns during this period to inform safer care processes moving forward. The aim of this preliminary analysis was to examine the nature of patient-reported safety concerns experienced during the first wave of the COVID-19 pandemic, using results from a cross-sectional survey of UK patients.

Approach

Data were collected as part of an ongoing, longitudinal mixed-methods cohort study exploring COVID-19 experiences of the adult UK population (COPE Cymru). An optional module exploring healthcare experiences during the first wave of the COVID-19 pandemic (March – June 2020) was included in the 3-month follow-up survey (June 2020). Respondents were asked: ‘while trying to access or receive NHS care during the coronavirus outbreak, have you or someone you care for experienced something that you thought was a ‘safety concern’?’. Subsequent questions related to the setting and nature of the safety concern, perceived seriousness and whether respondents believed it could have been avoided. Descriptive analyses were performed to characterise the sample and describe frequency, setting, nature, and seriousness of safety concerns.

Findings

From 3993 respondents to the survey module, 314 patients reported experiencing a safety concern. Most safety concerns were reported to occur in a general practice setting (n=121; 30%), followed by outpatient services (n=82; 21%), then A&E (n=47; 12%). Within primary care, the nature of most frequently relating to service access (19%) and diagnosis (17%). Overall, most safety concerns related to ‘access to services’ (n=105; 16.2%) or were ‘coronavirus specific’ (n=103; 15.8%) e.g. insufficient or improper use of personal protective equipment (PPE) worn by staff, inadequate hygiene / sanitisation procedures, cross-contamination between COVID and non-COVID patients, and lack of social distancing. Most respondents perceived their safety concern to be ‘serious’ and could have ‘definitely’ or ‘probably’ been avoided.

Consequences

These results reflect current trends of change to service access during the pandemic and highlight priority areas for targeted incident report analysis. Further research, through qualitative interviews with the same respondents, will explore patient-perceived contributory factors and outcomes of these concerns. This will be used to inform policy change to improve service delivery within primary and other healthcare settings moving forward and in future pandemics.