A preliminary taxonomy of medical errors in family practice.
OBJECTIVE
To develop a preliminary taxonomy of primary care medical errors.


METHODS
Qualitative analysis to identify categories of error reported during a randomized controlled trial of computer and paper reporting methods.


METHODS
The National Network for Family Practice and Primary Care Research.


METHODS
Family physicians.


METHODS
Medical error category, context, and consequence.


RESULTS
Forty two physicians made 344 reports: 284 (82.6%) arose from healthcare systems dysfunction; 46 (13.4%) were errors due to gaps in knowledge or skills; and 14 (4.1%) were reports of adverse events, not errors. The main subcategories were: administrative failure (102; 30.9% of errors), investigation failures (82; 24.8%), treatment delivery lapses (76; 23.0%), miscommunication (19; 5.8%), payment systems problems (4; 1.2%), error in the execution of a clinical task (19; 5.8%), wrong treatment decision (14; 4.2%), and wrong diagnosis (13; 3.9%). Most reports were of errors that were recognized and occurred in reporters' practices. Affected patients ranged in age from 8 months to 100 years, were of both sexes, and represented all major US ethnic groups. Almost half the reports were of events which had adverse consequences. Ten errors resulted in patients being admitted to hospital and one patient died.


CONCLUSIONS
This medical error taxonomy, developed from self-reports of errors observed by family physicians during their routine clinical practice, emphasizes problems in healthcare processes and acknowledges medical errors arising from shortfalls in clinical knowledge and skills. Patient safety strategies with most effect in primary care settings need to be broader than the current focus on medication errors.
Dovey
S M
SM
Robert Graham Center: Policy Studies in Family Practice and Primary Care, 2023 Massachusetts Ave NW, Washington, DC 20036, USA. sdovey@aafp.org
Meyers
D S
DS
Phillips
R L
RL
Green
L A
LA
Fryer
G E
GE
Galliher
J M
JM
Kappus
J
J
Grob
P
P
D000328:Adult; D000368:Aged; D002965:Classification; D002983:Clinical Competence; D018592:Cross-Over Studies; D005194:Family Practice / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000145:classification* / Q000706:statistics & numerical data; D008875:Middle Aged; D011320:Primary Health Care / Q000592:standards / Q000706:statistics & numerical data*; D012308:Risk Management; D014481:United States