Patient Safety Incidents Involving Sick Children in Primary Care in England and Wales: A Mixed Methods Analysis.
<h4>Background</h4>The UK performs poorly relative to other economically developed countries on numerous indicators of care quality for children. The contribution of iatrogenic harm to these outcomes is unclear. As primary care is the first point of healthcare contact for most children,...
Saved in:
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2017-01-01
|
| Series: | PLoS Medicine |
| Online Access: | https://doi.org/10.1371/journal.pmed.1002217 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850162859522129920 |
|---|---|
| author | Philippa Rees Adrian Edwards Colin Powell Peter Hibbert Huw Williams Meredith Makeham Ben Carter Donna Luff Gareth Parry Anthony Avery Aziz Sheikh Liam Donaldson Andrew Carson-Stevens |
| author_facet | Philippa Rees Adrian Edwards Colin Powell Peter Hibbert Huw Williams Meredith Makeham Ben Carter Donna Luff Gareth Parry Anthony Avery Aziz Sheikh Liam Donaldson Andrew Carson-Stevens |
| author_sort | Philippa Rees |
| collection | DOAJ |
| description | <h4>Background</h4>The UK performs poorly relative to other economically developed countries on numerous indicators of care quality for children. The contribution of iatrogenic harm to these outcomes is unclear. As primary care is the first point of healthcare contact for most children, we sought to investigate the safety of care provided to children in this setting.<h4>Methods and findings</h4>We undertook a mixed methods investigation of reports of primary care patient safety incidents involving sick children from England and Wales' National Reporting and Learning System between 1 January 2005 and 1 December 2013. Two reviewers independently selected relevant incident reports meeting prespecified criteria, and then descriptively analyzed these reports to identify the most frequent and harmful incident types. This was followed by an in-depth thematic analysis of a purposive sample of reports to understand the reasons underpinning incidents. Key candidate areas for strengthening primary care provision and reducing the risks of systems failures were then identified through multidisciplinary discussions. Of 2,191 safety incidents identified from 2,178 reports, 30% (n = 658) were harmful, including 12 deaths and 41 cases of severe harm. The children involved in these incidents had respiratory conditions (n = 387; 18%), injuries (n = 289; 13%), nonspecific signs and symptoms, e.g., fever (n = 281; 13%), and gastrointestinal or genitourinary conditions (n = 268; 12%), among others. Priority areas for improvement included safer systems for medication provision in community pharmacies; triage processes to enable effective and timely assessment, diagnosis, and referral of acutely sick children attending out-of-hours services; and enhanced communication for robust safety netting between professionals and parents. The main limitations of this study result from underreporting of safety incidents and variable data quality. Our findings therefore require further exploration in longitudinal studies utilizing case review methods.<h4>Conclusions</h4>This study highlights opportunities to reduce iatrogenic harm and avoidable child deaths. Globally, healthcare systems with primary-care-led models of delivery must now examine their existing practices to determine the prevalence and burden of these priority safety issues, and utilize improvement methods to achieve sustainable improvements in care quality. |
| format | Article |
| id | doaj-art-94e32dec26fb43bc9c1e166aee7ece51 |
| institution | OA Journals |
| issn | 1549-1277 1549-1676 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS Medicine |
| spelling | doaj-art-94e32dec26fb43bc9c1e166aee7ece512025-08-20T02:22:26ZengPublic Library of Science (PLoS)PLoS Medicine1549-12771549-16762017-01-01141e100221710.1371/journal.pmed.1002217Patient Safety Incidents Involving Sick Children in Primary Care in England and Wales: A Mixed Methods Analysis.Philippa ReesAdrian EdwardsColin PowellPeter HibbertHuw WilliamsMeredith MakehamBen CarterDonna LuffGareth ParryAnthony AveryAziz SheikhLiam DonaldsonAndrew Carson-Stevens<h4>Background</h4>The UK performs poorly relative to other economically developed countries on numerous indicators of care quality for children. The contribution of iatrogenic harm to these outcomes is unclear. As primary care is the first point of healthcare contact for most children, we sought to investigate the safety of care provided to children in this setting.<h4>Methods and findings</h4>We undertook a mixed methods investigation of reports of primary care patient safety incidents involving sick children from England and Wales' National Reporting and Learning System between 1 January 2005 and 1 December 2013. Two reviewers independently selected relevant incident reports meeting prespecified criteria, and then descriptively analyzed these reports to identify the most frequent and harmful incident types. This was followed by an in-depth thematic analysis of a purposive sample of reports to understand the reasons underpinning incidents. Key candidate areas for strengthening primary care provision and reducing the risks of systems failures were then identified through multidisciplinary discussions. Of 2,191 safety incidents identified from 2,178 reports, 30% (n = 658) were harmful, including 12 deaths and 41 cases of severe harm. The children involved in these incidents had respiratory conditions (n = 387; 18%), injuries (n = 289; 13%), nonspecific signs and symptoms, e.g., fever (n = 281; 13%), and gastrointestinal or genitourinary conditions (n = 268; 12%), among others. Priority areas for improvement included safer systems for medication provision in community pharmacies; triage processes to enable effective and timely assessment, diagnosis, and referral of acutely sick children attending out-of-hours services; and enhanced communication for robust safety netting between professionals and parents. The main limitations of this study result from underreporting of safety incidents and variable data quality. Our findings therefore require further exploration in longitudinal studies utilizing case review methods.<h4>Conclusions</h4>This study highlights opportunities to reduce iatrogenic harm and avoidable child deaths. Globally, healthcare systems with primary-care-led models of delivery must now examine their existing practices to determine the prevalence and burden of these priority safety issues, and utilize improvement methods to achieve sustainable improvements in care quality.https://doi.org/10.1371/journal.pmed.1002217 |
| spellingShingle | Philippa Rees Adrian Edwards Colin Powell Peter Hibbert Huw Williams Meredith Makeham Ben Carter Donna Luff Gareth Parry Anthony Avery Aziz Sheikh Liam Donaldson Andrew Carson-Stevens Patient Safety Incidents Involving Sick Children in Primary Care in England and Wales: A Mixed Methods Analysis. PLoS Medicine |
| title | Patient Safety Incidents Involving Sick Children in Primary Care in England and Wales: A Mixed Methods Analysis. |
| title_full | Patient Safety Incidents Involving Sick Children in Primary Care in England and Wales: A Mixed Methods Analysis. |
| title_fullStr | Patient Safety Incidents Involving Sick Children in Primary Care in England and Wales: A Mixed Methods Analysis. |
| title_full_unstemmed | Patient Safety Incidents Involving Sick Children in Primary Care in England and Wales: A Mixed Methods Analysis. |
| title_short | Patient Safety Incidents Involving Sick Children in Primary Care in England and Wales: A Mixed Methods Analysis. |
| title_sort | patient safety incidents involving sick children in primary care in england and wales a mixed methods analysis |
| url | https://doi.org/10.1371/journal.pmed.1002217 |
| work_keys_str_mv | AT philipparees patientsafetyincidentsinvolvingsickchildreninprimarycareinenglandandwalesamixedmethodsanalysis AT adrianedwards patientsafetyincidentsinvolvingsickchildreninprimarycareinenglandandwalesamixedmethodsanalysis AT colinpowell patientsafetyincidentsinvolvingsickchildreninprimarycareinenglandandwalesamixedmethodsanalysis AT peterhibbert patientsafetyincidentsinvolvingsickchildreninprimarycareinenglandandwalesamixedmethodsanalysis AT huwwilliams patientsafetyincidentsinvolvingsickchildreninprimarycareinenglandandwalesamixedmethodsanalysis AT meredithmakeham patientsafetyincidentsinvolvingsickchildreninprimarycareinenglandandwalesamixedmethodsanalysis AT bencarter patientsafetyincidentsinvolvingsickchildreninprimarycareinenglandandwalesamixedmethodsanalysis AT donnaluff patientsafetyincidentsinvolvingsickchildreninprimarycareinenglandandwalesamixedmethodsanalysis AT garethparry patientsafetyincidentsinvolvingsickchildreninprimarycareinenglandandwalesamixedmethodsanalysis AT anthonyavery patientsafetyincidentsinvolvingsickchildreninprimarycareinenglandandwalesamixedmethodsanalysis AT azizsheikh patientsafetyincidentsinvolvingsickchildreninprimarycareinenglandandwalesamixedmethodsanalysis AT liamdonaldson patientsafetyincidentsinvolvingsickchildreninprimarycareinenglandandwalesamixedmethodsanalysis AT andrewcarsonstevens patientsafetyincidentsinvolvingsickchildreninprimarycareinenglandandwalesamixedmethodsanalysis |