Abstract
BackgroundPatient safety research has focused largely on hospital settings despite the fact that in many countries, the majority of patient contacts are in primary care. The knowledge base about patient safety in primary care is developing but sparse and diagnostic error is a relatively understudied and an unmeasured area of patient safety. Diagnostic error rates vary according to how ‘error’ is defined but one suggested hallmark is clear evidence of ‘missed opportunity’ (MDOs) makes a correct or timely diagnosis to prevent them. While there is no agreed definition or method of measuring MDOs, retrospective manual chart or patient record reviews are a ‘gold standard’. This study protocol aims to (1) determine the incidence of MDOs in English general practice, (2) identify the confounding and contributing factors that lead to MDOs and (3) determine the (potential) impact of the detected MDOs on patients.Methods/DesignWe plan to conduct a two-phase retrospective review of electronic health records in the Greater Manchester (GM) area of the UK. In the first phase, clinician reviewers will calibrate their performance in identifying and assessing MDOs against a gold standard ‘primary reviewer’ through the use of ‘double’ reviews of records. The findings will enable a preliminary estimate of the incidence of MDOs in general practice, which will be used to calculate the number of records to be reviewed in the second phase in order to estimate the true incidence of MDO in general practice. A sample of 15 general practices is required for phase 1 and up to 35 practices for phase 2. In each practice, the sample will consist of 100 patients aged ≥18 years on 1 April 2013 who have attended a face-to-face ‘index consultation’ between 1 April 2013 and 31 March 2015. The index consultation will be selected randomly from each unique patient record, occurring between 1 July 2013 and 30 June 2014.DiscussionThere are no reliable estimates of safety problems related to diagnosis in English general practice. This study will lay the foundation for safety improvements in this area by providing a more reliable estimate of MDOs, their impact and their contributory factors.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-015-0296-z) contains supplementary material, which is available to authorized users.
Highlights
Patient safety research has focused largely on hospital settings despite the fact that in many countries, the majority of patient contacts are in primary care
There are no reliable estimates of safety problems related to diagnosis in English general practice
Patient safety has received considerable global attention since the publication of the landmark report ‘To Err is Human’ in 1999 [1]. This attention has been focused largely toward hospital settings leading to the identification of a so called ‘lost decade’ with respect to settings such as primary care [2]. This is despite the fact that in many countries, including the United Kingdom (UK), the majority of patient contacts are with health care providers in primary care
Summary
There are no reliable estimates of the incidence of MDOs in English general practice. As a result of this project, future research will have an available and a more reliable estimate of MDOs as a prerequisite to improvement, which the American Medical Association (AMA) has highlighted as a priority because the literature on improving safety in primary care is still evolving [2]. (DOCX 70 kb) Additional file 2: Information sheet. (DOCX 54 kb) Additional file 3: Consent form. (DOC 49 kb) Additional file 4: Data extraction form. (DOCX 47 kb) Additional file 5: Practice and clinician demographic form. (DOCX 31 kb) Additional file 6: Coding manual. All authors participated in the design and coordination of the study and helped to draft the manuscript.
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