Understanding the epidemiology of avoidable significant harm in primary care: protocol for a retrospective cross-sectional study

Article English OPEN
Bell, Brian G ; Campbell, Stephen ; Carson-Stevens, Andrew ; Evans, Huw Prosser ; Cooper, Alison ; Sheehan, Christina ; Rodgers, Sarah ; Johnson, Christine ; Edwards, Adrian ; Armstrong, Sarah ; Mehta, Rajnikant ; Chuter, Antony ; Donnelly, Ailsa ; Ashcroft, Darren M ; Lymn, Joanne ; Smith, Pam ; Sheikh, Aziz ; Boyd, Matthew ; Avery, Anthony J (2017)
  • Publisher: BMJ Publishing Group
  • Journal: BMJ Open (vol: 7)
  • Related identifiers: doi: 10.1136/bmjopen-2016-013786, pmc: PMC5318597
  • Subject: Protocol | 1696 | General practice / Family practice | PRIMARY CARE | Journal Article | 1506 | 1704 | 1703 | GENERAL MEDICINE (see Internal Medicine) | RA

Introduction: Most patient safety research has\ud focused on specialist-care settings where there is an\ud appreciation of the frequency and causes of medical\ud errors, and the resulting burden of adverse events.\ud There have, however, been few large-scale robust\ud studies that have investigated the extent and severity of\ud avoidable harm in primary care. To address this, we\ud will conduct a 12-month retrospective cross-sectional\ud study involving case note review of primary care\ud patients.\ud Methods and analysis: We will conduct electronic\ud searches of general practice (GP) clinical computer\ud systems to identify patients with avoidable significant\ud harm. Up to 16 general practices from 3 areas of\ud England (East Midlands, London and the North West)\ud will be recruited based on practice size, to obtain a\ud sample of around 100 000 patients. Our investigations\ud will include an ‘enhanced sample’ of patients with the\ud highest risk of avoidable significant harm. We will\ud estimate the incidence of avoidable significant harm\ud and express this as ‘per 100 000 patients per year’.\ud Univariate and multivariate analysis will be conducted\ud to identify the factors associated with avoidable\ud significant harm.\ud Ethics/Dissemination: The decision regarding\ud participation by general practices in the study is entirely\ud voluntary; the consent to participate may be withdrawn\ud at any time. We will not seek individual patient consent\ud for the retrospective case note review, but if patients\ud respond to publicity about the project and say they do\ud not wish their records to be included, we will follow\ud these instructions. We will produce a report for the\ud Department of Health’s Policy Research Programme and\ud several high-quality peer-reviewed publications in\ud scientific journals. The study has been granted a\ud favourable opinion by the East Midlands Nottingham 2\ud Research Ethics Committee (reference 15/EM/0411) and\ud Confidentiality Advisory Group approval for access to\ud medical records without consent under section 251 of\ud the NHS Act 2006 (reference 15/CAG/0182).
  • References (28)
    28 references, page 1 of 3

    1. Leape LL, Brennan TA, Laird NM, et al. The nature of adverse events in hospitalised patients: results from the Harvard Medical Practice Study II. N Engl J Med 1991;324:377-84.

    2. Kohn LT, Corrigan JM, Donaldson MS (Institute of Medicine). To err is human: building a safer health system. Washington, DC: National Academy Press, 2000.

    3. Vincent C, Neale G, Woloshynowych M. Adverse events in British hospitals: preliminary retrospective record review. BMJ 2001;322:517-19.

    4. Expert Group on Learning from Adverse Events in the NHS. An organisation with a memory. London: Stationery Office, 2000. http:// patientsafety.health.org.uk/resources/organisation-memory (accessed 14 Nov 2014)

    5. Landrigan CP, Parry GJ, Bones CB, et al. Temporal trends in rates of patient harm resulting from medical care. N Engl J Med 2010;363:2124-34.

    6. Baker GR, Norton PG, Flintoft V, et al. The Canadian adverse events study: the incidence of adverse events among hospital patients in Canada. CMAJ 2004;170:1678-86.

    7. Brennan TA, Leape LL, Laird NM, et al. Incidence of adverse events and negligence in hospitalised patients: results of the Harvard Medical Practice Study I. 1991. Qual Saf Health Care 2004;13:145-51.

    8. Davis P, Lay-Yee R, Briant R, et al. Adverse events in New Zealand public hospitals l. Occurrence and impact. N Z Med J 2002;115:U271.

    9. Schiøler T, Lipczak H, Pedersen BL, et al., Danish Adverse Event Study. Incidence of adverse events in hospitals. A retrospective study of medical records. Ugeskr Laeg 2001;163:5370-8.

    10. Thomas EJ, Studdert DM, Burstin HR, et al. Incidence and types of adverse events and negligent care in Utah and Colorado. Med Care 2000;38:261-71.

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