Abstract
BackgroundResearch on patient safety has focused largely on secondary care settings, and there is a dearth of knowledge relating to safety culture or climate, and safety climate improvement strategies, in the context of primary care. This is problematic given the high rates of usage of primary care services and the myriad of opportunities for clinical errors daily. The current research programme aimed to assess the effectiveness of an intervention derived from the Scottish Patient Safety Programme in Primary Care. The intervention consists of safety climate measurement and feedback and patient chart audit using the trigger review method. The purpose of this paper is to describe the background to this research and to present the methodology of this feasibility study in preparation for a future definitive RCT.MethodsThe SAP-C study is a feasibility study employing a randomised controlled pretest-posttest design that will be conducted in 10 general practices in the Republic of Ireland and Northern Ireland. Five practices will receive the safety climate intervention over a 9-month period. The five practices in the control group will continue care as usual but will complete the GP-SafeQuest safety climate questionnaire at baseline (month 1) and at the terminus of the intervention (month 9). The outcomes of the study include process evaluation metrics (i.e. rates of participant recruitment and retention, rates of completion of safety climate measures, qualitative data regarding participants’ perceptions of the intervention’s potential efficacy, acceptability, and sustainability), patient safety culture in intervention and control group practices at posttest, and instances of undetected patient harm identified through patient chart audit using the trigger review method.DiscussionThe planned study investigates an intervention to improve safety climate in Irish primary care settings. The resulting data may inform our knowledge of the frequency of undetected patient safety incidents in primary care, may contribute to improved patient safety practices in primary care settings, and may inform future research on patient safety improvement initiatives.Electronic supplementary materialThe online version of this article (doi:10.1186/s40814-016-0096-5) contains supplementary material, which is available to authorized users.
Highlights
Research on patient safety has focused largely on secondary care settings, and there is a dearth of knowledge relating to safety culture or climate, and safety climate improvement strategies, in the context of primary care
This study will investigate the impact of an intervention, derived from the Scottish Patient Safety Programme in Primary Care (SPSP-PC), on the safety climate of primary care practices
We will investigate if this intervention, comprising safety climate measurement and feedback using the GP-SafeQuest and patient chart audit using the trigger review method, results in changes in safety climate among intervention group general practices as compared to the control group and aids with the detection and remediation of instances of patient harm
Summary
Research on patient safety has focused largely on secondary care settings, and there is a dearth of knowledge relating to safety culture or climate, and safety climate improvement strategies, in the context of primary care. Lydon et al Pilot and Feasibility Studies (2016) 2:56 study of patient safety in primary care settings has lagged behind [3, 10,11,12] This slower uptake may relate to the perception of primary care delivery as a relatively low-risk endeavour far less likely to result in patient harm than secondary care services given the infrequency of adverse events in primary care and the lesser use of technology in the delivery of services [10]. While reports of safety climate in UK primary care settings are largely positive [15], there is a discrepancy in the report of “managerial” staff members and other employees that may indicate an overestimation of positive safety climate in these settings This suggestion is supported by research which has found that there are between 5 and 80 patient safety incidents, or errors, made per 100,000 primary care consultations [16]. British primary care physicians have noted a number of impediments to monitoring patient safety in their workplaces including a lack of access to pertinent data or uncertainty regarding the metrics of patient safety that should be monitored, a lack of clarity regarding policies and procedures for assessing patient safety and addressing incidents of harm, and a lack of clarity surrounding whose responsibility is the monitoring of patient care [20]
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