ArticleBMJ open2012
Clinical decision making in a high-risk primary care environment: a qualitative study in the UK.
Article in BMJ open, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 19 papers, 1 of them a synthesis that pooled it.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
19 citing papers in PubMed, 1 synthesis or guideline pooled it.
- How Do Contexts Affect Physicians' Clinical Reasoning? A Narrative Review.MedEdPublish (2016) · 2020Pooled it
- Using Virtual Patients to Explore the Clinical Reasoning Skills of Medical Students: Mixed Methods Study.Journal of medical Internet research · 2021Trial
- Safety-netting advice documentation in out-of-hours primary care: a retrospective cohort from 2013 to 2020.The British journal of general practice : the journal of the Royal College of General Practitioners · 2025Article
- Actions of a cancer surveillance technical group based on the perspective of advocacy.Revista da Escola de Enfermagem da U S P · 2023Article
- Reasoning like a doctor or like a nurse? A systematic integrative review.Frontiers in medicine · 2023Review
- The Impact of Point-of-Care Blood C-Reactive Protein Testing on Prescribing Antibiotics in Out-of-Hours Primary Care: A Mixed Methods Evaluation.Antibiotics (Basel, Switzerland) · 2022Article
- Optimising GPs' communication of advice to facilitate patients' self-care and prompt follow-up when the diagnosis is uncertain: a realist review of 'safety-netting' in primary care.BMJ quality & safety · 2022Review
- Clinician perspectives on having point of care tests made available to them during out of hours home visiting.BMC family practice · 2021Article
- Identifying safe care processes when GPs work in or alongside emergency departments: a realist evaluation.The British journal of general practice : the journal of the Royal College of General Practitioners · 2021Article
- Understanding the Effect of Electronic Prehospital Medical Records in Ambulances: A Qualitative Observational Study in a Prehospital Setting.International journal of environmental research and public health · 2021Observational
- Safety netting for primary care: evidence from a literature review.The British journal of general practice : the journal of the Royal College of General Practitioners · 2019Review
- [Description of contributing factors in adverse events related to patient safety and their preventability].Atencion primaria · 2018Article
- Probability or Reasoning: Current Thinking and Realistic Strategies for Improved Medical Decisions.Korean journal of family medicine · 2017Review
- Primary care REFerral for EchocaRdiogram (REFER) in heart failure: a diagnostic accuracy study.The British journal of general practice : the journal of the Royal College of General Practitioners · 2017Observational
- Missed opportunities for diagnosis: lessons learned from diagnostic errors in primary care.The British journal of general practice : the journal of the Royal College of General Practitioners · 2015Article
- Article
- Blame the Patient, Blame the Doctor or Blame the System? A Meta-Synthesis of Qualitative Studies of Patient Safety in Primary Care.PloS one · 2015Article
- The safety netting behaviour of first contact clinicians: a qualitative study.BMC family practice · 2013Article
- Identifying early warning signs for diagnostic errors in primary care: a qualitative study.BMJ open · 2012Article
Corrections and comments
- Erratum issuedCorrection.2012
Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveExamine clinical reasoning and decision making in an out of hours (OOH) primary care setting to gain insights into how general practitioners (GPs) make clinical decisions and manage risk in this environment.
designSemi-structured interviews using open-ended questions.
settingA 2-month qualitative interview study conducted in Oxfordshire, UK.
participants21 GPs working in OOH primary care.
resultsThe most powerful themes to emerge related to dealing with urgent potentially high-risk cases, keeping patients safe and responding to their needs, while trying to keep patients out of hospital and the concept of 'fire fighting'. There were a number of well-defined characteristics that GPs reported making presentations easy or difficult to deal with. Severely ill patients were straightforward, while the older people, with complex multisystem diseases, were often difficult. GPs stopped collecting clinical information and came to clinical decisions when high-risk disease and severe illness requiring hospital attention has been excluded; they had responded directly to the patient's needs and there was a reliable safety net in place. Learning points that GPs identified as important for trainees in the OOH setting included the importance of developing rapport in spite of time pressures, learning to deal with uncertainty and learning about common presentations with a focus on critical cues to exclude severe illness.
conclusionsThe findings support suggestions that improvements in primary care OOH could be achieved by including automated and regular timely feedback system for GPs and individual peer and expert clinician support for GPs with regular meetings to discuss recent cases. In addition, trainee support and mentoring to focus on clinical skills, knowledge and risk management issues specific to OOH is currently required. Investigating the stopping rules used for diagnostic closure may provide new insights into the root causes of clinical error in such a high-risk setting.
Identifiers
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.