Patient safety in primary care: incident reporting and significant event reviews in British general practice

Abstract

Over the past 20 years, healthcare has adapted to the 'quality revolution' by moving away from direct provision and hierarchical control mechanisms. In their place, new structures based on contractual relationships are being developed coupled with attempts to create an organisational culture that shares learning and that scrutinises existing practice so that it can be improved. The issue here is that contractual arrangements require surveillance, monitoring, regulation and governance systems that can be perceived as antipathetic to the examination of practice and subsequent learning. Historically, reporting levels from general practice have remained low; little information is shared and consequently lessons are not shared across the general practice community. Given large-scale under-engagement of general practitioners (GPs) in incident reporting systems, significant event analysis is advocated to encourage sharing of information about incidents to inform the patient safety agenda at a local and national level. Previous research has concentrated on the secondary care environment and little is known about the situation in primary care, where the majority of patient contacts with healthcare occur. To explore attitudes to incident reporting, the study adopted a qualitative approach to GPs working in a mixture of urban and rural practices reporting to a Welsh Local Health Board. The study found that GPs used significant event analysis methodology to report incidents within their practice, but acknowledged under-reporting. They were less enthusiastic about reporting externally. A number of barriers exist to reporting, including insufficient time to report, lack of feedback, fear of blame, and damage to reputations and patient confidence in a competitive environment. If incident reporting processes are perceived as supportive and formative, and where protected time is allocated to discuss incidents, then GPs are willing to participate. They also need to know how the information is used, and whether lessons are being learnt from errors.

Patient Safety Culture in Tunisia: Defining Challenges and Opportunities

“…Also, this underreporting can be explained by the fact that the commission of error is always considered as a lack of skill and rarely seen as a learning opportunity. A number of barriers exist to reporting, including insufficient time to report, lack of feedback, fear of blame, and damage to reputations and patient confidence in a competitive environment [24]. Here, we highlight the dimension of "nonpunitive response to error," which as mentioned above, has the second lowest score.…”

“…Patient safety is a center of interest in healthcare, internationally, and error reduction can be improved by reporting and learning from errors [22]. A very low positive response for event reporting is expected in primary care because it is known to lack standardized reporting systems and reporting culture [20,24]. Although primary care may imply lower risks compared to hospitals, the large volume of contacts in this sector suggests that safety incidents can be expected to occur [23].…”

Perceptions and Attitudes towards Medication Error Reporting in Primary Care Clinics: A Qualitative Study in Malaysia

“…The simplicity of the reporting form [18], [22], adequate training on the reporting process [18], anonymous reporting [22], [28], adequate feedback received on the reporting [18], [22], perceived severity of error [18], [22], [28] and supportive and open working environment [29], [30] were among the reasons deemed to increase the likelihood of reporting MEs.…”

Patient safety in ambulatory care from the patient's perspective: a retrospective, representative telephone survey

“…For this reason, it is internationally recommended to include patients themselves as sources of information for PSP recording 10–13. Only patients are able to report on the effects of treatments across sectors and over long periods of time; their information on incidents is usually more accurate than those of physicians,14 who also show more resentment towards PSP reporting 15…”