title: Patient safety in Dutch primary care: a study protocol.
abstract: BACKGROUND
  Insight into the frequency and seriousness of potentially unsafe situations may be the first step towards improving patient safety. Most patient safety attention has been paid to patient safety in hospitals. However, in many countries, patients receive most of their healthcare in primary care settings. There is little concrete information about patient safety in primary care in the Netherlands. The overall aim of this study was to provide insight into the current patient safety issues in Dutch general practices, out-of-hours primary care centres, general dental practices, midwifery practices, and allied healthcare practices. The objectives of this study are: to determine the frequency, type, impact, and causes of incidents found in the records of primary care patients; to determine the type, impact, and causes of incidents reported by Dutch healthcare professionals; and to provide insight into patient safety management in primary care practices.
  
  
  METHODS
  The study consists of three parts: a retrospective patient record study of 1,000 records per practice type was conducted to determine the frequency, type, impact, and causes of incidents found in the records of primary care patients (objective one); a prospective component concerns an incident-reporting study in each of the participating practices, during two successive weeks, to determine the type, impact, and causes of incidents reported by Dutch healthcare professionals (objective two); to provide insight into patient safety management in Dutch primary care practices (objective three), we surveyed organizational and cultural items relating to patient safety. We analysed the incidents found in the retrospective patient record study and the prospective incident-reporting study by type of incident, causes (Eindhoven Classification Model), actual harm (severity-of-outcome domain of the International Taxonomy of Medical Errors in Primary Care), and probability of severe harm or death.
  
  
  CONCLUSIONS
  To estimate the frequency of incidents was difficult. Much depended on the accuracy of the patient records and the professionals' consensus about which types of adverse events have to be recognized as incidents.
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. M.Harmsen@iq.umcn.nl.
authors.forename: Mirjam
authors.initials: M
authors.lastname: Harmsen
authors.forename: Sander
authors.initials: S
authors.lastname: Gaal
authors.forename: Simone
authors.initials: S
authors.lastname: van Dulmen
authors.forename: Eimert
authors.initials: E
authors.lastname: de Feijter
authors.forename: Paul
authors.initials: P
authors.lastname: Giesen
authors.forename: Annelies
authors.initials: A
authors.lastname: Jacobs
authors.forename: Lucie
authors.initials: L
authors.lastname: Martijn
authors.forename: Theodorus
authors.initials: T
authors.lastname: Mettes
authors.forename: Wim
authors.initials: W
authors.lastname: Verstappen
authors.forename: Ria
authors.initials: R
authors.lastname: Nijhuis-van der Sanden
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing