Prevalence and consequences of patient safety incidents in general practice in the Netherlands: a retrospective medical record review study

TLDR

Patient safety risks exist in both hospitals and general practice, yet quantitative studies of incidents in large primary‑care samples are scarce, and the high patient volume in general practice presents unique challenges for improvement. The study aimed to assess patient safety in Dutch general practice and identify areas for improvement through a retrospective record review. The authors retrospectively reviewed records of a random sample of 1,000 patients from 20 Dutch general practices over one year, recording incidents, their causes, and patient impact. They identified 211 incidents (95 % CI 185–241), 58 of which affected patients, 7 led to hospital admission, and none caused permanent disability or death, indicating that most incidents had limited health impact.

Abstract

Patient safety can be at stake in both hospital and general practice settings. While severe patient safety incidents have been described, quantitative studies in large samples of patients in general practice are rare. This study aimed to assess patient safety in general practice, and to show areas where potential improvements could be implemented.We conducted a retrospective review of patient records in Dutch general practice. A random sample of 1,000 patients from 20 general practices was obtained. The number of patient safety incidents that occurred in a one-year period, their perceived underlying causes, and impact on patients' health were recorded.We identified 211 patient safety incidents across a period of one year (95% CI: 185 until 241). A variety of types of incidents, perceived causes and consequences were found. A total of 58 patient safety incidents affected patients; seven were associated with hospital admission; none resulted in permanent disability or death.Although this large audit of medical records in general practices identified many patient safety incidents, only a few had a major impact on patients' health. Improving patient safety in this low-risk environment poses specific challenges, given the high numbers of patients and contacts in general practice.