title: Patient safety in out-of-hours primary care: a review of patient records.
abstract: BACKGROUND
  Most patients receive healthcare in primary care settings, but relatively little is known about patient safety. Out-of-hours contacts are of particular importance to patient safety. Our aim was to examine the incidence, types, causes, and consequences of patient safety incidents at general practice cooperatives for out-of-hours primary care and to examine which factors were associated with the occurrence of patient safety incidents.
  
  
  METHODS
  A retrospective study of 1,145 medical records concerning patient contacts with four general practice cooperatives. Reviewers identified records with evidence of a potential patient safety incident; a physician panel determined whether a patient safety incident had indeed occurred. In addition, the panel determined the type, causes, and consequences of the incidents. Factors associated with incidents were examined in a random coefficient logistic regression analysis.
  
  
  RESULTS
  In 1,145 patient records, 27 patient safety incidents were identified, an incident rate of 2.4% (95% CI: 1.5% to 3.2%). The most frequent incident type was treatment (56%). All incidents had at least partly been caused by failures in clinical reasoning. The majority of incidents did not result in patient harm (70%). Eight incidents had consequences for the patient, such as additional interventions or hospitalisation. The panel assessed that most incidents were unlikely to result in patient harm in the long term (89%). Logistic regression analysis showed that age was significantly related to incident occurrence: the likelihood of an incident increased with 1.03 for each year increase in age (95% CI: 1.01 to 1.04).
  
  
  CONCLUSIONS
  Patient safety incidents occur in out-of-hours primary care, but most do not result in harm to patients. As clinical reasoning played an important part in these incidents, a better understanding of clinical reasoning and guideline adherence at GP cooperatives could contribute to patient safety.
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, the Netherlands.
authors.forename: Marleen
authors.initials: M
authors.lastname: Smits
authors.forename: Linda
authors.initials: L
authors.lastname: Huibers
authors.forename: Brian
authors.initials: B
authors.lastname: Kerssemeijer
authors.forename: Eimert
authors.initials: E
authors.lastname: de Feijter
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
authors.forename: Paul
authors.initials: P
authors.lastname: Giesen
mesh_terms: D039602:After-Hours Care / Q000592:standards* / Q000706:statistics & numerical data; D019090:Case Management; D054869:Clinical Audit; D002983:Clinical Competence; D005194:Family Practice / Q000458:organization & administration* / Q000592:standards; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D016015:Logistic Models; D008297:Male; D019300:Medical Errors / Q000517:prevention & control; D008499:Medical Records; D009426:Netherlands; D010043:Outcome and Process Assessment, Health Care / Q000592:standards; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000592:standards* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D018570:Risk Assessment; D017751:Safety Management; D014218:Triage