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Tools for primary care patient safety: a narrative review.

Spencer R, Campbell SM - BMC Fam Pract (2014)

Bottom Line: Diagnostic error and results handling appear infrequently (<1% of total literature) despite their relative importance.However, many of the tools have yet to be used in quality improvement strategies and cycles such as plan-do-study-act (PDSA) so there is a dearth of evidence of their utility in improving as opposed to measuring and highlighting safety issues.The lack of focus on diagnostics, systems safety and results handling provide direction and priorities for future research.

View Article: PubMed Central - PubMed

Affiliation: NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, 7th Floor, Williamson Building, Manchester M13 9PL, UK. stephen.campbell@manchester.ac.uk.

ABSTRACT

Background: Patient safety in primary care is a developing field with an embryonic but evolving evidence base. This narrative review aims to identify tools that can be used by family practitioners as part of a patient safety toolkit to improve the safety of the care and services provided by their practices.

Methods: Searches were performed in 6 healthcare databases in 2011 using 3 search stems; location (primary care), patient safety synonyms and outcome measure synonyms. Two reviewers analysed the results using a numerical and thematic analyses. Extensive grey literature exploration was also conducted.

Results: Overall, 114 Tools were identified with 26 accrued from grey literature. Most published literature originated from the USA (41%) and the UK (23%) within the last 10 years. Most of the literature addresses the themes of medication error (55%) followed by safety climate (8%) and adverse event reporting (8%). Minor themes included; informatics (4.5%) patient role (3%) and general measures to correct error (5%). The primary/secondary care interface is well described (5%) but few specific tools for primary care exist. Diagnostic error and results handling appear infrequently (<1% of total literature) despite their relative importance. The remainder of literature (11%) related to referrals, Out-Of-Hours (OOH) care, telephone care, organisational issues, mortality and clerical error.

Conclusions: This review identified tools and indicators that are available for use in family practice to measure patient safety, which is crucial to improve safety and design a patient safety toolkit. However, many of the tools have yet to be used in quality improvement strategies and cycles such as plan-do-study-act (PDSA) so there is a dearth of evidence of their utility in improving as opposed to measuring and highlighting safety issues. The lack of focus on diagnostics, systems safety and results handling provide direction and priorities for future research.

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Related in: MedlinePlus

‘Toolkit’ review stages. Graph 1 –a) illustration of the literature base in primary care patient safety 1987-2011from Pubmed b) Papers from the review divided by the annual Pubmed output for the same year.
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Fig1: ‘Toolkit’ review stages. Graph 1 –a) illustration of the literature base in primary care patient safety 1987-2011from Pubmed b) Papers from the review divided by the annual Pubmed output for the same year.

Mentions: Grey literature results are not included in the following calculations and flow diagrams; results are instead included in the list of tools found in web Additional file1: Appendix 3 (where they are clearly marked as being from grey sources). Using the process described in Figure 1, we selected approximately 10% (n = 1311) of the original search total (n = 13,240) for evaluation of abstracts; titles excluded at this stage were clearly not of relevance e.g. relating to non-healthcare safety topics. Abstracts were then analysed for tools, after excluding papers which were from the correct setting but which did not contain any interventions; around 14% of the abstracts were included for full paper analysis (n = 189).Figure 1


Tools for primary care patient safety: a narrative review.

Spencer R, Campbell SM - BMC Fam Pract (2014)

‘Toolkit’ review stages. Graph 1 –a) illustration of the literature base in primary care patient safety 1987-2011from Pubmed b) Papers from the review divided by the annual Pubmed output for the same year.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4288623&req=5

Fig1: ‘Toolkit’ review stages. Graph 1 –a) illustration of the literature base in primary care patient safety 1987-2011from Pubmed b) Papers from the review divided by the annual Pubmed output for the same year.
Mentions: Grey literature results are not included in the following calculations and flow diagrams; results are instead included in the list of tools found in web Additional file1: Appendix 3 (where they are clearly marked as being from grey sources). Using the process described in Figure 1, we selected approximately 10% (n = 1311) of the original search total (n = 13,240) for evaluation of abstracts; titles excluded at this stage were clearly not of relevance e.g. relating to non-healthcare safety topics. Abstracts were then analysed for tools, after excluding papers which were from the correct setting but which did not contain any interventions; around 14% of the abstracts were included for full paper analysis (n = 189).Figure 1

Bottom Line: Diagnostic error and results handling appear infrequently (<1% of total literature) despite their relative importance.However, many of the tools have yet to be used in quality improvement strategies and cycles such as plan-do-study-act (PDSA) so there is a dearth of evidence of their utility in improving as opposed to measuring and highlighting safety issues.The lack of focus on diagnostics, systems safety and results handling provide direction and priorities for future research.

View Article: PubMed Central - PubMed

Affiliation: NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, 7th Floor, Williamson Building, Manchester M13 9PL, UK. stephen.campbell@manchester.ac.uk.

ABSTRACT

Background: Patient safety in primary care is a developing field with an embryonic but evolving evidence base. This narrative review aims to identify tools that can be used by family practitioners as part of a patient safety toolkit to improve the safety of the care and services provided by their practices.

Methods: Searches were performed in 6 healthcare databases in 2011 using 3 search stems; location (primary care), patient safety synonyms and outcome measure synonyms. Two reviewers analysed the results using a numerical and thematic analyses. Extensive grey literature exploration was also conducted.

Results: Overall, 114 Tools were identified with 26 accrued from grey literature. Most published literature originated from the USA (41%) and the UK (23%) within the last 10 years. Most of the literature addresses the themes of medication error (55%) followed by safety climate (8%) and adverse event reporting (8%). Minor themes included; informatics (4.5%) patient role (3%) and general measures to correct error (5%). The primary/secondary care interface is well described (5%) but few specific tools for primary care exist. Diagnostic error and results handling appear infrequently (<1% of total literature) despite their relative importance. The remainder of literature (11%) related to referrals, Out-Of-Hours (OOH) care, telephone care, organisational issues, mortality and clerical error.

Conclusions: This review identified tools and indicators that are available for use in family practice to measure patient safety, which is crucial to improve safety and design a patient safety toolkit. However, many of the tools have yet to be used in quality improvement strategies and cycles such as plan-do-study-act (PDSA) so there is a dearth of evidence of their utility in improving as opposed to measuring and highlighting safety issues. The lack of focus on diagnostics, systems safety and results handling provide direction and priorities for future research.

Show MeSH
Related in: MedlinePlus