Abstract
BackgroundPatient safety issues in primary health care and in emergency departments have not been as thoroughly explored as patient safety issues in the hospital setting. Knowledge is particularly sparse regarding which patients have a higher risk of harm in these settings. The objective was to evaluate which patient-related factors were associated with risk of harm in patients with reports of safety incidents.MethodsA case–control study performed in primary health care and emergency departments in Sweden. In total, 4536 patients (cases) and 44,949 controls were included in this study. Cases included patients with reported preventable harm in primary health care and emergency departments from January 1st, 2011 until December 31st, 2016.ResultsPsychiatric disease, including all psychiatric diagnoses regardless of severity, nearly doubled the risk of being a reported case of preventable harm (odds ratio, 1.96; p < 0.001). Adjusted for income and education there was still an increased risk (odds ratio, 1.69; p < 0.001). The preventable harm in this group was to 46% diagnostic errors of somatic disease.ConclusionPatients with psychiatric illness are at higher risk of preventable harm in primary care and the emergency department. Therefore, this group needs extra attention to prevent harm.
Highlights
Patient safety issues in primary health care and in emergency departments have not been as thoroughly explored as patient safety issues in the hospital setting
It can be argued that primary health care (PHC) and Emergency departments (ED) are different settings, but both these settings represent the first contact with healthcare for patients experiencing new symptoms and both contexts have a high density of diagnostic decision making
We concluded that the association between psychiatric illness and the risk of preventable harm was equivalent for emergency care and primary care patients
Summary
Patient safety issues in primary health care and in emergency departments have not been as thoroughly explored as patient safety issues in the hospital setting. In first-line health care, diagnostic error—defined as delayed, missed, or incorrect diagnoses [8] —is a common type among serious preventable harm [9,10,11]. In these cases, patients do not receive the correct treatment in a timely manner. The frequency of diagnostic errors in outpatient care has been estimated at 5% [12] Both PHC and emergency departments (EDs) are often stressful environments with high rates of diagnostic decision-making
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