How safe is primary care? A systematic review.

Area of Science:

• Healthcare Quality and Safety
• Primary Care Medicine
• Medical Error Analysis

Background:

• Patient safety in hospitals is well-studied, but less is known about safety in primary care settings.
• Improving patient safety is a key policy and practice objective.

Purpose of the Study:

• To investigate the frequency of patient safety incidents in primary care.
• To determine the association between these incidents and patient harm.

Main Methods:

• A systematic review of published and unpublished studies from 1980 to 2014.
• Inclusion of studies on any type of patient safety incident.
• Critical appraisal and narrative synthesis of data from 9 systematic reviews and 100 primary studies.

Main Results:

• Patient safety incidents occurred at rates from <1 to 24 per 100 consultations.
• Population-based studies indicated a median of 2-3 incidents per 100 consultations.
• Approximately 4% of incidents were associated with severe harm, with diagnostic and prescribing errors being most frequent.

Conclusions:

• Safety incidents are relatively common in primary care.
• Most incidents do not lead to severe patient harm.
• Diagnostic and prescribing errors represent the most significant risks for avoidable harm.