Safety learning system development--incident reporting component for family practice.

OBJECTIVE: To determine the required components for developing the reporting components of a safety learning system (SLS) for community-based family practice. METHODS: Multiple databases were searched for all languages for all types of papers related to medical safety in community practice: Books@Ovid, BIOSIS Previews, CDSR, ACP Journal Club, DARE, CCTR, Ageline, AMED, CINAHL, EMBASE, HealthSTAR, Ovid MEDLINE In-Process, Other Non-Indexed Citations, Ovid MEDLINE, PsycINFO, HAPI and PsycBOOKS. A grey literature search was done in Google. RESULTS: The online search identified 190 papers. English abstracts were read and the full papers (or chapters) were retrieved for 90, of which 18 were deemed appropriate. The grey literature search revealed 18 additional papers, and an additional 12 papers were identified from bibliographies of included papers. The common themes identified from the articles became the main consideration for developing an SLS for family practice and include current and past initiatives, system design, incident reporting form and classification system. CONCLUSION: There is a small but growing body of literature concerning the requirements for developing the reporting component of an SLS for family practice. For the reporting component of an SLS to be successful, there needs to be strong leadership, voluntary reporting, legal protection and feedback to reporters.

The importance of communication in secondary fragility fracture treatment and prevention.

INTRODUCTION: We report on a Canadian longitudinal qualitative case study of midlife women with fragility fractures, their treating orthopaedic surgeons and family physicians. METHODS: Women and their treating physicians were followed for an average of one year post fracture to investigate the health outcomes and what, if any, follow-up occurred aimed at secondary fracture prevention. The final dataset includes 223 interviews gathered from women aged 40 to 65 with fragility fractures, orthopaedic surgeons and family physicians. RESULTS: The circle of care for those with fragility fractures is disrupted at vital communication junctures: (1) the inconsistent flow of information between acute care institutions and family physicians; (2) unidirectional and inconsistent communication from orthopaedic surgeons to family physicians; and (3) competing demands of the cast clinic environment and patient expectations. It is not the lack of will that is undermining the consistent and detailed communication among patients, physicians and institutions. It is the episodic nature of fracture care that makes communication among involved parties difficult, if not impossible. CONCLUSIONS: Communication about events, acuity and clear expectations around roles and follow-up is urgently needed to improve communication throughout the circle of care to support secondary fracture prevention. Fractures from a standing height or similar trauma in women aged 40 to 65 should be treated as suspicious fractures and followed-up to investigate the underlying bone condition. This article reports on challenges and barriers to clear communication among women, their orthopaedic surgeons and family physicians that is necessary for follow-up and prevention of future fractures.