Sander Gaal

What do primary care physicians and researchers consider the most important patient safety improvement strategies

BackgroundAlthough it has been increasingly recognised that patient safety in primary care is important, little is known about the feasibility and effectiveness of different strategies to improve patient safety in primary care. In this study, we aimed to identify the most important strategies by consulting an international panel of primary care physicians and researchers.MethodsA web-based survey was undertaken in an international panel of 58 individuals from eight countries with a strong primary care system. The questionnaire consisted of 38 strategies to improve patient safety. We asked the respondents whether these strategies were currently used in their own country, and whether they felt them to be important.ResultsMost of the 38 presented strategies were seen as important by a majority of the participants, but the use of strategies in daily practice varied widely. Strategies that yielded the highest scores (>70%) regarding importance included a good medical record system (82% felt this was very important, while 83% said it was implemented in more than half of the practices), good telephone access (71% importance, 83% implementation), standards for record keeping (75% importance, 62% implementation), learning culture (74% importance, 10% implementation), vocational training on patient safety for GPs (81% importance, 24% implementation) and the presence of a patient safety guideline (81% importance, 15% implementation).ConclusionAn international panel of primary care physicians and researchers felt that many different strategies to improve patient safety were important. Highly important strategies with poor implementation included a culture that is positive for patient safety, education on patient safety for physicians, and the presence of a patient safety guideline.

Patient safety features are more present in larger primary care practices

OBJECTIVES This study aimed to explore whether specific characteristics of a general practice organization were associated with aspects of patient safety management. METHODS Secondary analysis of data from 271 primary care practices, collected in 10 European countries. These data were collected by a practice visitor and physician questionnaires. For this study we constructed 10 measures of patient safety, covering 45 items as outcomes, and 6 measures of practice characteristics as possible predictors for patient safety. RESULTS Eight of the 10 patient safety measures yielded higher scores in larger practices (practices with more than 2 general practitioners). Medication safety (B 0.64), practice building safety (B 0.49) and incident reporting items (B 0.47) showed the strongest associations with practice size. Also measures on hygiene (B 0.37), medical record keeping (B 0.30), quality improvement (B 0.28), professional competence (B 0.24) and organized patient feedback items (B 0.24) had higher scores in larger practices. CONCLUSION Larger general practice practices may have better safety management, although through our measurements no causal relationship could be established in this study.

Complaints Against Family Physicians Submitted to Disciplinary Tribunals in the Netherlands: Lessons for Patient Safety

PURPOSE We analyzed the disciplinary law verdicts concerning family physicians, submitted to the Dutch disciplinary law system, to identify domains of high risk of harm for patients in family practice. METHODS The Dutch disciplinary law system offers patients the opportunity to file complaints against physicians outside a legal malpractice system, without possibility of financial compensation in case of verdicts in which the physician was found to be at fault. We performed an analysis of 250 random disciplinary law verdicts on Dutch family physicians submitted to disciplinary tribunals and published between 2008 and 2010. Our analysis focused on clinical domains represented in the verdicts with serious permanent damage or death. RESULTS Of the 74 complaints with a serious health outcome, 44.6% (n = 33) were related to a wrong diagnosis, 23.0% (n = 17) to insufficient care, 8.1% (n = 6) to a wrong treatment, 8.1% (n = 6) to a late arrival at a house visit, 5.4% (n = 4) to a late referral to the hospital, and 1.4% (n = 1) to insufficient information given; 9.5% (n = 7) consisted of other complaints. The wrong or late diagnosis-related cases mostly consisted of myocardial infarction and stroke (35.1%) and malignancies (33.7%). The family physician was disciplined as a result of 37 of these 74 complaints (50%). Logistic regression analysis showed that a serious outcome was associated with a higher probability of disciplinary measures (B=0.703; P =.02) CONCLUSIONS The disciplinary law system in the Netherlands differs fundamentally from a legal malpractice system. It can be used to learn from patients’ complaints with a view on improving patient safety.

A research agenda on patient safety in primary care. Recommendations by the LINNEAUS collaboration on patient safety in primary care.

ABSTRACT Background: Healthcare can cause avoidable serious harm to patients. Primary care is not an exception, and the relative lack of research in this area lends urgency to a better understanding of patient safety, the future research agenda and the development of primary care oriented safety programmes. Objective: To outline a research agenda for patient safety improvement in primary care in Europe and beyond. Methods: The LINNEAUS collaboration partners analysed existing research on epidemiology and classification of errors, diagnostic and medication errors, safety culture, and learning for and improving patient safety. We discussed ideas for future research in several meetings, workshops and congresses with LINNEAUS collaboration partners, practising GPs, researchers in this field, and policy makers. Results: This paper summarizes and integrates the outcomes of the LINNEAUS collaboration on patient safety in primary care. It proposes a research agenda on improvement strategies for patient safety in primary care. In addition, it provides background information to help to connect research in this field with practicing GPs and other healthcare workers in primary care. Conclusion: Future research studies should target specific primary care domains, using prospective methods and innovative methods such as patient involvement.

Patient safety improvement programmes for primary care. Review of a Delphi procedure and pilot studies by the LINNEAUS collaboration on patient safety in primary care

ABSTRACT Background: To improve patient safety it is necessary to identify the causes of patient safety incidents, devise solutions and measure the (cost-) effectiveness of improvement efforts. Objective: This paper provides a broad overview with practical guidance on how to improve patient safety. Methods: We used modified online Delphi procedures to reach consensus on methods to improve patient safety and to identify important features of patient safety management in primary care. Two pilot studies were carried out to assess the value of prospective risk analysis (PRA), as a means of identifying the causes of a patient safety incident. Results: A range of different methods can be used to improve patient safety but they have to be contextually specific. Practice organization, culture, diagnostic errors and medication safety were found to be important domains for further improvement. Improvement strategies for patient safety could benefit from insights gained from research on implementation of evidence-based practice. Patient involvement and prospective risk analysis are two promising and innovative strategies for improving patient safety in primary care. Conclusion: A range of methods is available to improve patient safety, but there is no ‘magic bullet.’ Besides better use of the available methods, it is important to use new and potentially more effective strategies, such as prospective risk analysis.

Patient safety in primary allied health care: what can we learn from incidents in a Dutch exploratory cohort study?

Background:Research on patient safety in allied healthcare is scarce. Our aim was to document patient safety in primary allied healthcare in the Netherlands and to identify factors associated with incidents. Design and Subject:A retrospective study of 1000 patient records in a representative sample of 20 allied healthcare practices was combined with a prospective incident-reporting study. Measures:All records were reviewed by trained researchers to identify patient safety incidents. The incidents were classified and analyzed, using the Prevention and Recovery Information System for Monitoring and Analysis method. Factors associated with incidents were examined in a logistic regression analysis. Results:In 18 out of 1000 (1.8%; 95% confidence interval: 1.0–2.6) records an incident was detected. The main causes of incidents were related to errors in clinical decisions (89%), communication with other healthcare providers (67%), and monitoring (56%). The probability of incidents was higher if more care providers had been involved and if patient records were incomplete (37% of the records). No incidents were reported in the prospective study. Conclusions:The absolute number of incidents was low, which could imply a low risk of harm in Dutch primary allied healthcare. Nevertheless, incompleteness of the patient records and the fact that incidents were mainly caused through human actions suggest that a focus on clinical reasoning and record keeping is needed to further enhance patient safety. Improvements in record keeping will be necessary before accurate incident reporting will be feasible and valid.

Organisational targets of patient safety improvement programs in primary care; an international web-based survey.

BackgroundOrganisational problems contribute to many errors in healthcare delivery. Our objective was to identify the most important organisational items in primary care which could be targeted by programs to improve patient safety.MethodsA web-based survey was undertaken in an international panel of 65 experts on patient safety from 20 countries. They were asked to rate 52 patient safety items on a five-point Likert scale which regards importance of each item for use for educational interventions to improve patient safety.ResultsThe following 7 organizational items were regarded ‘extremely important’ by more than 50% of the experts: the use of sterile equipment with small surgical procedures (63%), the availability of adequate emergency drugs in stock (60%), regular cleaning of facilities (59%), the use of sterile surgical gloves when recommended (57%), the availability of at least one adequately trained staff member to deal with collapse and need for resuscitation (56%), adequate information handover when a patient is discharged from the hospital (56%) and periodically training of GPs in basic life support and other medical emergencies (53%).ConclusionSeven organisational items were consistently prioritized; other items may be relevant in specific countries only. The logical next step is to develop and evaluate interventions targeted at these items.

Dieper kijken bij calamiteiten op de HAP

SamenvattingCalamiteiten op de huisartsenpost (HAP) zijn nooit helemaal uit te bannen. Het is goed dat er nu een landelijk overzicht is gemaakt met waardevolle suggesties om ze te voorkomen. Maar we zijn er nog niet en we moeten nog een slag dieper kijken. Er is vooral behoefte aan gevalideerde beslisondersteuning voor triagisten en dokters.

Patiëntveiligheid in de eerste lijn

SamenvattingVerstappen HJM, Gaal S, Wensing M. Patiëntveiligheid in de eerste lijn. Huisarts Wet 2016;59(8):350-3. De gezondheidszorg kan vermijdbare ernstige schade veroorzaken. Dat is voor de huisartsgeneeskunde niet anders en het relatieve gebrek aan onderzoek binnen de eerste lijn betekent dat meer (wetenschappelijke) aandacht voor patiëntveiligheid broodnodig is. Het LINNEAUS-PC-netwerk heeft onderzoek geanalyseerd naar de epidemiologie en classificatie van fouten (bijvoorbeeld diagnostische of medicatiefouten), veiligheidscultuur en mogelijkheden tot het verbeteren van de veiligheid van de patiënt. Deze beschouwing vat de belangrijkste bevindingen samen en stelt een onderzoeksagenda voor ter verbetering van de patiëntveiligheid in de eerste lijn. Het toekomstig onderzoek zou zich vooral moeten richten op specifieke huisartsgeneeskundige aspecten en op specifieke huisartsgeneeskundige domeinen via prospectieve en innovatieve methoden, zoals de betrokkenheid van de patiënt, ter verbetering van de patiëntveiligheid.AbstractVerstappen HJM, Gaal S, Wensing M. Patient safety in primary care. Huisarts Wet 2016;59(8):350-3. Medical care can cause severe, avoidable injury. This is also true for general practice medicine, and the relative lack of research in primary care means that more attention should be paid to patient safety. The LINNEAUS-PC-network has analysed studies of the epidemiology and classification of errors (such as diagnostic or treatment errors), safety culture, and the possibilities to improve patient safety. The article reviews the main findings and presents a research agenda for improving patient safety in primary care. Future research into improving patient safety should focus on specific aspects and domains of general practice medicine, using prospective and innovative methods, such as patient involvement.