scholarly journals Patients’ perception of safety climate in Irish general practice: a cross-sectional study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Caoimhe Madden ◽  
Sinéad Lydon ◽  
Andrew W. Murphy ◽  
Paul O’Connor
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
General Practice ◽  
Patient Safety ◽  
Safety Climate ◽  
Patient Perceptions ◽  
Free Text ◽  
Patient Report ◽  
Patient Risk ◽  
Perceptions Of Safety

Abstract Background Although patients have the potential to provide important information on patient safety, considerably fewer patient-report measures of safety climate (SC) have been applied in the primary care setting as compared to secondary care. Our aim was to examine the application of a patient-report measure of safety climate in an Irish population to understand patient perceptions of safety in general practice and identify potential areas for improvement. Specifically, our research questions were: 1. What are patients’ perceptions of SC in Irish general practice? 2. Do patient risk factors impact perceptions of SC? 3. Do patient responses to an open-ended question about safety enhance our understanding of patient safety beyond that obtained from a quantitative measure of SC? Methods The Patient Perspective of Safety in General Practice (PPS-GP) survey was distributed to primary care patients in Ireland. The survey consisted of both Likert-response items, and free-text entry questions in relation to the safety of care. A series of five separate hierarchical regressions were used to examine the relationship between a range of patient-related variables and each of the survey subscales. A deductive content analysis approach was used to code the free-text responses. Results A total of 584 completed online and paper surveys were received. Respondents generally had positive perceptions of safety across all five SC subscales of the PPS-GP. Regarding patient risk factors, younger age and being of non-Irish nationality were consistently associated with more negative SC perceptions. Analysis of the free-text responses revealed considerably poorer patient perceptions (n = 85, 65.4%) of the safety experience in primary care. Conclusion Our findings indicate that despite being under-utilised, patients’ perceptions are a valuable source of information for measuring SC, with promising implications for safety improvement in general practice. Further consideration should be given to how best to utilise this data in order to improve safety in primary care.

Development and validation of a patient-report measure of safety climate for general practice

2021 ◽  
Author(s):  
Caoimhe Madden ◽  
Sinéad Lydon ◽  
Andrew W Murphy ◽  
Paul O’Connor
Keyword(s):  
General Practice ◽  
Patient Safety ◽  
Internal Consistency ◽  
Convergent Validity ◽  
Safety Climate ◽  
Improve Patient Safety ◽  
Patient Report ◽  
Cross Sectional ◽  
Cross Sectional Design ◽  
Report Measure

Abstract Background Patients remain an under-utilized source of information on patient safety, as reflected by the dearth of patient-report measures of safety climate, particularly for use in general practice settings. Extant measures are marked by poor coverage of safety climate domains, inadequate psychometric properties and/or lack of consideration of usability. Objective To develop a novel patient-report measure of safety climate specifically for completion by general practice patients, and to establish the validity, reliability and usability of this measure. Methods An iterative process was used to develop the safety climate measure, with patient and general practitioner input. A cross-sectional design was employed to examine the validity (content, construct and convergent), reliability (internal consistency), and usability (readability and burden) of the measure. Results A total of 584 general practice patients completed the measure. The exploratory factor analysis identified five factors pertaining to safety climate in general practice: Feeling of Safety with GP; Practice Staff Efficiency and Teamwork; Staff Stress and Workload; Patient Knowledge and Accountability, and; Safety Systems and Behaviours. These factors strongly correlated with two global safety measures, demonstrating convergent validity. The measure showed strong internal consistency, and was considered usable for patients as indicated by readability and duration of completion. Conclusion Our novel measure of safety climate for use in general practice demonstrates favourable markers of validity, reliability and usability. This measure will provide a mechanism for the patient voice to be heard in patient safety measurement, and to be used to improve patient safety in general practice.

Development of 2 Short Patient-Report Questionnaires of Patient Safety in Primary Care

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Luke T.A. Mounce ◽  
Nde-Eshimuni Salema ◽  
Jaheeda Gangannagaripalli ◽  
Ignacio Ricci-Cabello ◽  
Anthony J. Avery ◽  
...  
Keyword(s):  
Primary Care ◽  
Patient Safety ◽  
Patient Report

General Practice Recruitment for People at Risk of Schizophrenia: The Buckingham Experience

2000 ◽  
Vol 34 (1_suppl) ◽  
pp. A131-A136 ◽  
Author(s):  
Ian R. H. Falloon
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Primary Care ◽  
At Risk ◽  
General Practice ◽  
Early Detection ◽  
Psychotic Disorders ◽  
Community Sample ◽  
Signs And Symptoms ◽  
Psychotic Episode

Objective The process of detecting people at high risk of schizophrenia from a community sample is a major challenge for prevention of psychotic disorders. The aim of this paper is to describe early detection procedures that can be implemented in primary care settings. Methods A selected literature review is supplemented by experiences and data obtained during the Buckingham Integrated Mental Health Care Project. Results General medical practitioners have been favoured as the agents most likely to prove helpful in detecting the key risk factors that predict the onset of schizophrenic disorders, as well as in recognising the earliest signs and symptoms of these conditions. However, the practical problems of screening for multiple and subtle risk factors in general practice are substantial, and general practitioners (GPs) often have difficulty recognising the earliest signs of a psychotic episode. A range of strategies to assist GPs detect early signs of psychosis in their patients are considered. Conclusions It is feasible to implement primary care setting early detection procedures for people at risk of schizophrenia. Implementation is aided by the use of a brief screening questionnaire, training sessions and case supervision; and increased collaboration with mental health services and other community agencies.

scholarly journals Using the electronic health record to build a culture of practice safety: evaluating the implementation of trigger tools in one general practice

2018 ◽  
Vol 68 (669) ◽  
pp. e279-e285 ◽  
Author(s):  
Tom Margham ◽  
Natalie Symes ◽  
Sally A Hull
Keyword(s):  
Primary Care ◽  
At Risk ◽  
General Practice ◽  
Patient Safety ◽  
Ease Of Use ◽  
High Yield ◽  
Case Review ◽  
Patients At Risk ◽  
Barriers To Implementation ◽  
Narrative Evaluation

BackgroundIdentifying patients at risk of harm in general practice is challenging for busy clinicians. In UK primary care, trigger tools and case note reviews are mainly used to identify rates of harm in sample populations.AimThis study explores how adaptions to existing trigger tool methodology can identify patient safety events and engage clinicians in ongoing reflective work around safety.Design and settingMixed-method quantitative and narrative evaluation using thematic analysis in a single East London training practice.MethodThe project team developed and tested five trigger searches, supported by Excel worksheets to guide the case review process. Project evaluation included summary statistics of completed worksheets and a qualitative review focused on ease of use, barriers to implementation, and perception of value to clinicians.ResultsTrigger searches identified 204 patients for GP review. Overall, 117 (57%) of cases were reviewed and 62 (53%) of these cases had patient safety events identified. These were usually incidents of omission, including failure to monitor or review. Key themes from interviews with practice members included the fact that GPs’ work is generally reactive and GPs welcomed an approach that identified patients who were ‘under the radar’ of safety. All GPs expressed concern that the tool might identify too many patients at risk of harm, placing further demands on their time.ConclusionElectronic trigger tools can identify patients for review in domains of clinical risk for primary care. The high yield of safety events engaged clinicians and provided validation of the need for routine safety checks.

scholarly journals Physician factors associated with increased risk for complaints in primary care emergency services: a case – control study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Svein Zander Bratland ◽  
Valborg Baste ◽  
Knut Steen ◽  
Esperanza Diaz ◽  
Svein Gjelstad ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Patient Safety ◽  
Emergency Services ◽  
Medical Training ◽  
Organizational Factors ◽  
Case Control ◽  
Study Patient ◽  
Increased Risk ◽  
Patient Safety Incidents

Abstract Background Patient safety incidents defined as any unintended or unexpected incident that could have or were judged to have led to patient harm, are reported as relatively common. In this study patient complaints have been used as an indicator to uncover the occurrence of patient safety incidents in primary care emergency units (PCEUs) in Norway. Methods Ten PCEUs in major cities and rural parts of Norway participated. These units cover one third of the Norwegian population. A case-control design was applied. The case was the physician that evoked a complaint. The controls were three randomly chosen physicians from the same PCEU as the physician having evoked the complaint. The following variables regarding the physicians were chosen: gender, citizenship at, and years after authorization as physician, and specialty in general practice. The magnitude of patient contact was defined as the workload at the PCEU. The physicians’ characteristics and workload were extracted from the medical records from the fourteen-day period prior to the consultation that elicited the complaint. The rest of the variables were then obtained from the Norwegian physician position register. Logistic regression was used to estimate odds ratio for complaints both unadjusted and adjusted for the independent variables. The data were analyzed using SPSS (Version25) and STATA. Results A total of 78 cases and 217 controls were included during 18 months (September 1st 2015 till March 1st 2017). The risk of evoking a complaint was significantly higher for physicians without specialty in general practice, and lower for those with medium low and medium high workload compared to physicians with no duty during the fourteen-day period prior to the index consultation. The limited strength of the study did not make it possible to assess any correlation between workload and the other variables (physician’s gender, seniority and citizenship at time of authorization). Conclusions Continuous medical training and achieving the specialty in general practice were decisively associated with a reduced risk for complaints in primary care emergency services. Future research should focus on elements promoting quality of care such as continuing education, duty rosters and other structural and organizational factors.

Measuring perceptions of safety climate in primary care: a cross-sectional study

2010 ◽  
Vol 18 (1) ◽  
pp. 135-142 ◽  
Author(s):  
Carl de Wet ◽  
Paul Johnson ◽  
Robert Mash ◽  
Alex McConnachie ◽  
Paul Bowie
Keyword(s):  
Primary Care ◽  
Safety Climate ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Perceptions Of Safety

A Review of the Use of Routine Data on CHD in General Practice Research in Scotland

2005 ◽  
Vol 50 (3) ◽  
pp. 109-113 ◽  
Author(s):  
G McLean
Keyword(s):  
Risk Factors ◽  
Primary Care ◽  
General Practice ◽  
Literature Review ◽  
Research Methods ◽  
Routine Data ◽  
Practice Research ◽  
Primary Care Research ◽  
Care Research ◽  
Extensive Range

Background: The primary aim of the Platform Project is to maximise the use of routine data for-primary care research in Scotland. Aims: To assess the extent to which routine data ts available and has been used in studies on CHD in General Practice research in Scotland. To assess the advantages and limitations of using routine data in this setting Methods: Literature review using a variety of databases catalogues and websites, bibliographies of articles retrieved and searching through journals by hand not available electronically. Results: This review has found that the use of routine data in CHD studies in General Practice research in Scotland remains small. There has been little work undertaken which has combined the use of routine data with other research methods. Limitations with routine data exist particularly with regard to risk factors and ethnicity. However, despite such limitations there exists an increasingly extensive range of data, which exists to help explain tends in CHD, which so far has been largely underused.

scholarly journals Development of the Prototype Concise Safe Systems Checklist Tool for General Practice

2020 ◽  
Author(s):  
Ian J Litchfield ◽  
Rachel Spencer ◽  
Brian Bell ◽  
Anthony Avery ◽  
Katherine Perryman ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Patient Safety ◽  
Primary Care Patient ◽  
Safety Information ◽  
Care Patient ◽  
Ease Of Use ◽  
Structured Interviews ◽  
Practice Staff ◽  
Safety Issues

Abstract Background In the course of producing a patient safety toolkit for primary care, we identified the need for a concise safe-systems checklist designed to address areas of patient safety which are under-represented in mandatory requirements and existing tools. This paper describes the development of a prototype checklist designed to be used in busy general practice environments to provide an overview of key patient safety related processes and prompt practice wide-discussion. Methods An extensive narrative review and a survey of world-wide general practice organisations were used to identify existing primary care patient safety issues and tools. A RAND panel of international experts rated the results, summarising the findings for importance and relevance. The checklist was created to include areas that are not part of established patient safety tools or mandatory and legal requirements. Four main themes were identified: information flow, practice safety information, prescribing, and use of IT systems from which a 13 item checklist was trialled in 16 practices resulting in a nine item prototype checklist, which was tested in eight practices. Qualitative data on the utility and usability of the prototype was collected through a series of semi-structured interviews.Results In testing the prototype four of nine items on the checklist were achieved by all eight practices. Three items were achieved by seven of eight practices and two items by six of eight practices. Participants welcomed the brevity and ease of use of the prototype, that it might be used within time scales at their discretion and its ability to engage a range of practice staff in relevant discussions on the safety of existing processes. The items relating to prescribing safety were considered particularly useful. Conclusions As a result of this work the concise patient safety checklist tool, specifically designed for general practice, has now been made available as part of an online Patient Safety Toolkit hosted by the Royal College of General Practitioners. Senior practice staff such as practice managers and GP partners should find it a useful tool to understand the safety of less explored yet important safety processes within the practice.

scholarly journals A focused mapping review and synthesis of a priori risk factors associated with medical misconduct

2019 ◽  
Vol 8 (2) ◽  
pp. e000538
Author(s):  
Edward Croft ◽  
Maria Tighe Clark ◽  
Nikolaos Efstathiou ◽  
Caroline Bradbury-Jones
Keyword(s):  
Risk Factors ◽  
General Practice ◽  
Patient Safety ◽  
A Priori ◽  
The European Union ◽  
Medical Practitioners ◽  
The Public ◽  
Factors Associated ◽  
Mapping Review ◽  
The Uk

BackgroundMedical misconduct is an international problem. It is judged according to whether a doctor has endangered the health of the public. Little is known about the risk factors associated with medical misconduct. To inform patient safety, we undertook a focused mapping review and synthesis (FMRS) of tribunal reports retrieved from the Medical Practitioners Tribunal Service (MPTS).MethodsA four-phase FMRS was undertaken: (1) identification and retrieval of 1-year tribunal transcripts from the MPTS (focus), (2) analysis of transcripts to identify patterns mapped to ‘a priori’ risk factors (mapping), (3) peer review of the data (calibration) and (4) creation of a risk profile (synthesis).ResultsOut of the 351 investigative tribunals, 249 (70.94%) resulted in a guilty verdict. 82.73% of all guilty verdicts led to the removal of the doctor from practice. Through the identification of four a priori risk factors, we developed a model of risk associated with medical misconduct: (1) being male, (2) primary medical qualification (PMQ) outside of the UK, (3) working within general practice and surgical specialties, and (4) having passed PMQ more than 20 years ago. Notable ‘unconfirmed’ factors, such as locum work, PMQ achieved outside of the European Union, increasing age and lack of clinical guidance are also relevant to what is deemed professional behaviour and what is not.ConclusionsThe findings can inform debates about patient safety and lay the groundwork for further research into medical misconduct. Prospective studies should focus on confirming the contributory factors and relationship between these four a priori risk factors for medical misconduct: being male, PMQ outside of the UK, increasing age and working in general practice or surgical settings.

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