Abstract
BackgroundIn the UK, while most primary care contacts are uncomplicated, safety incidents do occur and result in patient harm, for example, failure to recognise a patient’s deterioration in health.AimTo determine the patient and healthcare factors associated with potentially missed acute deterioration in health.Design and settingCohort of patients registered with English Clinical Practice Research Datalink general practices between 1 April 2014 and 31 December 2017 with linked hospital data.MethodA potentially missed acute deterioration was defined as a patient having a self-referred admission to hospital having been seen in primary care by a GP in the 3 days beforehand. All diagnoses and subsets of commonly-reported missed conditions were analysed..ResultsA total of 116 097 patients contacted a GP 3 days before an emergency admission. Patients with sepsis (adjusted odds ratio [aOR] 1.09, 95% confidence interval [CI] = 1.01 to 1.18) or urinary tract infections (aOR 1.09, 95% CI = 1.04 to 1.14) were more likely to self-refer. The duration of GP appointments was associated with self-referral. On average, a 5-minute increase in appointment time resulted in a 10% decrease in the odds of self-referred admissions (aOR 0.90, 95% CI = 0.89 to 0.91). Patients having a telephone consultation (compared with face-to-face consultation) (aOR 1.14, 95% CI = 1.11 to 1.18) previous health service use, and presence of comorbidities were also associated with self-referred admission.ConclusionDifferentiating acute deterioration from self-limiting conditions can be difficult for clinicians, particularly in patients with sepsis, urinary tract infections, or long-term conditions. The findings of this study support the call for longer GP consultations and caution against reliance on telephone consultations in primary care; however, more research is needed to understand the underlying mechanisms.
Highlights
In the UK, the National Health Service (NHS) general practitioners (GP) provide most first-contact healthcare,1 with over 300 million primary care consultations annually within England alone.2 The majority of contacts are harm free
Differentiating deterioration from self-limiting conditions can be difficult for clinicians, in patients with sepsis, urinary tract infection or pyelonephritis (UTI) or with long-term conditions
Our findings supports the call for longer GP consultations and cautions reliance on telephone consultations in primary care; research is needed to understand the underlying mechanisms
Summary
In the UK, the National Health Service (NHS) general practitioners (GP) provide most first-contact healthcare, with over 300 million primary care consultations annually within England alone. The majority of contacts are harm free. While some incidents are not preventable (e.g. unexpected complications during the provision of correct care) others such as failure to recognise serious illness (or patient deterioration) can contribute to avoidable harm.. A single study from the UK, investigating delayed escalation of care in deteriorating patients, focused on out-ofhours primary care provision, and did not link to data on other healthcare contacts. Studies investigating diagnostic errors are more common, where the majority are considered to take place during patient assessment, and presence of comorbidity often contributed. Our use of primarysecondary care linked data is a novel approach to recognise potentially missed deterioration in primary care, (Figure 1). Safety incidents resulting in patient harm occur, such as failure to recognise a patient’s deterioration in health. Aim We aimed to determine patient and healthcare factors associated with potentially missed deterioration
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