Safety incidents in the primary care office setting.

BACKGROUND: In the United Kingdom, 26% of child deaths have identifiable failures in care. Although children account for 40% of family physicians' workload, little is known about the safety of care in the community setting. Using data from a national patient safety incident reporting system, this study aimed to characterize the pediatric safety incidents occurring in family practice. METHODS: We undertook a retrospective, cross-sectional, mixed methods study of pediatric reports submitted to the UK National Reporting and Learning System from family practice. Analysis involved detailed data coding using multiaxial frameworks, descriptive statistical analysis, and thematic analysis of a special-case sample of reports. Using frequency distributions and cross-tabulations, the relationships between incident types and contributory factors were explored. RESULTS: Of 1788 reports identified, 763 (42.7%) described harm to children. Three crosscutting priority areas were identified: medication management, assessment and referral, and treatment. The 4 incident types associated with the most harmful outcomes are errors associated with diagnosis and assessment, delivery of treatment and procedures, referrals, and medication provision. Poor referral and treatment decisions in severely unwell or vulnerable children, along with delayed diagnosis and insufficient assessment of such children, featured prominently in incidents resulting in severe harm or death. CONCLUSION: This is the first analysis of nationally collected, family practice-related pediatric safety incident reports. Recommendations to mitigate harm in these priority areas include mandatory pediatric training for all family physicians; use of electronic tools to support diagnosis, management, and referral decision-making; and use of technological adjuncts such as barcode scanning to reduce medication errors.

Laparoscopic cholecystectomy: device-related errors revealed through a national database.

Laparoscopic techniques represent a key milestone in the development of modern surgery, offering a step change in quality of care, patient satisfaction and efficiency in use of health service resources. Laparoscopy is most widely used for gall bladder surgery. As would be expected with the introduction of any new technology, the early phase of development was accompanied by complications in its use. Arguably some of these should have been anticipated, but nevertheless standards and training programs were subsequently put in place to secure a more consistent standard of care across the UK. Now that this early learning curve has largely been negotiated, we wanted to examine the nature of the errors associated with laparoscopic gall bladder surgery, particularly in relation to equipment. We used data from the largest error-reporting system in the world to examine the problem of equipment-related incidents amongst patients who had laparoscopic cholecystectomy. Over the 6-year period 2004-2010, the number of such reports increased 15-fold, whilst the growth in use of the procedure itself increased 1.3-fold. The majority of the increase was in device-related errors. User-related errors constituted a smaller proportion of errors. Whilst most surgeons appear to carry out laparoscopic surgery with a low level of harm to their patients, problems with their equipment remains a risk for many procedures. In some ways, this is an easier problem to address than one associated with competency. A risk associated with faulty, substandard or misused equipment is one that should be minimized in a 21st Century surgical service.