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World Book of Family Medicine – European Edition 2015 6. Susannah F, Maeve D. Health Online 2013. Pew Research Center’s Internet & American Life Project, 2013. 7. Topol E. The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. New York: Basic Books; 2012. 58
World Book of Family Medicine – European Edition 2015 John Sandars j.e.sandars@sheffield.ac.uk 17 – Threats to Patient Safety in Primary Care: A Review of the Research into the Frequency and Nature of Errors in Primary Care John Sandars MD Professor, Academic Unit of Medical Education, The Medical School The University of Sheffield This WONCA Conference presentation was based on a literature review that had been sponsored in 2001 by the Department of Health in the UK. Several databases were systematically reviewed, the key findings of which showed that medical error occurred between five and 80 times per 100,000 consultations, and these errors were mainly related to the processes involved in diagnosis and treatment (1). Prescribing and prescription errors were identified to occur in up to 11% of all prescriptions, and these were mainly related to errors in dose. An important aspect of this review was to highlight firstly, the wide variety of definitions of the various threats to patient safety that were used to identify the frequency and nature of these threats and secondly, the different methods used to identify threats to patient safety. These findings are of great importance if a comprehensive understanding of the frequency and possible causes of threats to patient safety is to be obtained. This understanding is essential for making appropriate interventions, including policies and protocols, to reduce threats to patient safety, with the ultimate aim of improving patient care. The main approaches to identifying threats to patient safety are incident reporting, systematic identification (such as by observing clinical practice), and medico-legal and patient complaint databases and qualitative interviews. All of these approaches reveal different aspects since some of the events may, or may not, have caused actual harm and the identification may only be through mandatory reporting, with greater emphasis on the less common but more serious events. Overall, the variety in the reported frequency and type of threat to patient safety depends on the different perspectives obtained from family physicians, primary health care workers and patients. A recent study has confirmed these findings, noting that patient surveys identified the highest number of events and pharmacist reports for the lowest number (2). Many of these events reported by patients are likely to have caused minimal harm but can be regarded as an indicator of potential causes of more serious threats to patient safety. The causes of threats to patient safety are usually a combination of inter-dependent factors (3). A study in primary care found that about half of the threats to patient safety were due to “situational” factors and that these events were often linked to serious potential consequences. The most frequent contributing factor was the organisation of work in primary care, including the excessive demands of working in a complex clinical environment, as well as the fragmentation of healthcare across the variety of different health care providers in primary care (4). Dealing with complexity is typical of the work of primary care and it is not surprising that this factor is a major contributory cause of threats to patient safety. A recent 59
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Family Medicine

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