Safety incidents in the primary care office setting.
BACKGROUND
In the United Kingdom, 26% of child deaths have identifiable failures in care. Although children account for 40% of family physicians' workload, little is known about the safety of care in the community setting. Using data from a national patient safety incident reporting system, this study aimed to characterize the pediatric safety incidents occurring in family practice.


METHODS
We undertook a retrospective, cross-sectional, mixed methods study of pediatric reports submitted to the UK National Reporting and Learning System from family practice. Analysis involved detailed data coding using multiaxial frameworks, descriptive statistical analysis, and thematic analysis of a special-case sample of reports. Using frequency distributions and cross-tabulations, the relationships between incident types and contributory factors were explored.


RESULTS
Of 1788 reports identified, 763 (42.7%) described harm to children. Three crosscutting priority areas were identified: medication management, assessment and referral, and treatment. The 4 incident types associated with the most harmful outcomes are errors associated with diagnosis and assessment, delivery of treatment and procedures, referrals, and medication provision. Poor referral and treatment decisions in severely unwell or vulnerable children, along with delayed diagnosis and insufficient assessment of such children, featured prominently in incidents resulting in severe harm or death.


CONCLUSIONS
This is the first analysis of nationally collected, family practice-related pediatric safety incident reports. Recommendations to mitigate harm in these priority areas include mandatory pediatric training for all family physicians; use of electronic tools to support diagnosis, management, and referral decision-making; and use of technological adjuncts such as barcode scanning to reduce medication errors.
Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, Wales;
Philippa
P
Rees
Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, Wales;
Adrian
A
Edwards
Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland;
Sukhmeet
S
Panesar
Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, Wales;
Colin
C
Powell
Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, Wales;
Ben
B
Carter
Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, Wales;
Huw
H
Williams
Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia;
Peter
P
Hibbert
Department of Anaesthesia, Institute for Professionalism and Ethical Practice and Department of Anesthesia, Boston Children's Hospital, Boston, Massachusetts;
Donna
D
Luff
Department of Pediatrics, and Institute for Healthcare Improvement, Cambridge, Massachusetts;
Gareth
G
Parry
Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, Wales;
Sharon
S
Mayor
Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom;
Anthony
A
Avery
Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts;
Aziz
A
Sheikh
Department of Surgery and Cancer, Imperial College London, London, United Kingdom; and.
Sir Liam
SL
Donaldson
Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, Wales; Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada carson-stevensap@cardiff.ac.uk.
Andrew
A
Carson-Stevens
D002648:Child; D003430:Cross-Sectional Studies; D005194:Family Practice; D006801:Humans; D019300:Medical Errors / Q000706:statistics & numerical data*; D009819:Office Visits; D061214:Patient Safety; D011320:Primary Health Care; D012189:Retrospective Studies; D006113:United Kingdom