Philippa Rees1, Adrian Edwards1, Sukhmeet Panesar2, Colin Powell3, Ben Carter1, Huw Williams1, Peter Hibbert4, Donna Luff5, Gareth Parry6, Sharon Mayor1, Anthony Avery7, Aziz Sheikh8, Sir Liam Donaldson9, Andrew Carson-Stevens10. 1. Cochrane Institute of Primary Care and Public Health, Cardiff University, Cardiff, Wales; 2. Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, Scotland; 3. Institute of Molecular and Experimental Medicine, School of Medicine, Cardiff University, Cardiff, Wales; 4. Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia; 5. Department of Anaesthesia, Institute for Professionalism and Ethical Practice and Department of Anesthesia, Boston Children's Hospital, Boston, Massachusetts; 6. Department of Pediatrics, and Institute for Healthcare Improvement, Cambridge, Massachusetts; 7. Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom; 8. 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; 9. Department of Surgery and Cancer, Imperial College London, London, United Kingdom; and. 10. 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.
Abstract
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. CONCLUSION: 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.
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. CONCLUSION: 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.
Authors: Philippa Rees; Adrian Edwards; Colin Powell; Huw Prosser Evans; Ben Carter; Peter Hibbert; Meredith Makeham; Aziz Sheikh; Liam Donaldson; Andrew Carson-Stevens Journal: Vaccine Date: 2015-06-26 Impact factor: 3.641
Authors: Andrew Carson-Stevens; Peter Hibbert; Anthony Avery; Amy Butlin; Ben Carter; Alison Cooper; Huw Prosser Evans; Russell Gibson; Donna Luff; Meredith Makeham; Paul McEnhill; Sukhmeet S Panesar; Gareth Parry; Philippa Rees; Emma Shiels; Aziz Sheikh; Hope Olivia Ward; Huw Williams; Fiona Wood; Liam Donaldson; Adrian Edwards Journal: BMJ Open Date: 2015-12-01 Impact factor: 2.692
Authors: Philippa Rees; Adrian Edwards; Colin Powell; Peter Hibbert; Huw Williams; Meredith Makeham; Ben Carter; Donna Luff; Gareth Parry; Anthony Avery; Aziz Sheikh; Liam Donaldson; Andrew Carson-Stevens Journal: PLoS Med Date: 2017-01-17 Impact factor: 11.069