Frequency of and harm associated with primary care safety incidents

Am J Manag Care. 2012 Sep 1;18(9):e323-37.


Objective: To assess frequency and severity of patient safety incidents in primary care.

Study design: Cross-sectional survey of health-care professionals in Swiss primary care offices.

Methods: Physicians and nurses in primary care offices were surveyed about the frequency and severity of 23 safety incidents. Differences between professional groups and types of offices were analyzed. Reported incidents were classified in a matrix.

Results: A total of 630 individuals (50.2% physicians, 49.8% nurses) participated. Among them, 30% of physicians (95% confidence interval [CI] 25%-35%) and 16.6% of nurses (95% CI 12%-21%) reported that at least 1 of the incidents occurred daily or weekly in their offices (c2 16.1, P <.001). On average, each responder reported a total of 92 incidents during the preceding 12 months (mean of 117 events for physicians, mean of 66 events for nurses; P <.001). Documentation failure was reported most frequently.The highest fraction of last occurrences with severe injury or death was for diagnostic errors (4.1%). Unadjusted for caseload, staff working in medical centers reported higher frequencies of several incidents. The frequency-harm matrix suggests that triage by nurse at initial contact, diagnostic errors, medication errors, failure to monitor patients after medical procedures, and test or intervention errors should be prioritized for action.

Conclusions: This study presents a supplemental approach to identification of safety threats in primary care. Many incidents occur regularly and are highly relevant for healthcare professionals' daily work.The results offer guidance on setting priorities for patient safety in primary care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Confidence Intervals
  • Cross-Sectional Studies
  • Diagnostic Errors
  • Health Care Surveys
  • Humans
  • Iatrogenic Disease / epidemiology*
  • Outpatients
  • Patient Care / standards
  • Patient Care / statistics & numerical data*
  • Primary Health Care / statistics & numerical data*
  • Retrospective Studies
  • Risk Assessment / methods
  • Risk Management / statistics & numerical data*
  • Safety / statistics & numerical data*
  • Switzerland / epidemiology
  • Triage