ArticleBMJ quality & safety2021
Incidence, nature and causes of avoidable significant harm in primary care in England: retrospective case note review.
Article in BMJ quality & safety, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 2 of them syntheses that pooled it.
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Who cites it
39 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Evidence on the links between patient experience and safety: a systematic review.BMJ open quality · 2026Pooled it
- Digital patient safety interventions in primary care: a systematic review and meta-analysis.BMC medicine · 2026Pooled it
- Trial
- A multifaceted risk management program to improve the reporting rate of patient safety incidents in primary care: a cluster-randomised controlled trial.BMC primary care · 2024Trial
- Patient safety practices in an innovative digital landscape: an interview study on triage in Swedish digital primary care.Scandinavian journal of primary health care · 2026Article
- General practice follow-up after hospital discharge in older adults: retrospective record analysis in UK primary care.The British journal of general practice : the journal of the Royal College of General Practitioners · 2026Article
- The incidence of avoidable healthcare-associated harm in prisons in England: a retrospective case note review.BMJ quality & safety · 2026Observational
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- Article
- Comparison of Physician Assistant and Medical Students' Clinical Reasoning Processes Using an Online Patient Simulation Tool to Support Clinical Reasoning (eCREST): Mixed Methods Study.JMIR medical education · 2025Article
- The evolution of patient-reported safety concerns during the COVID-19 pandemic within a series of study questionnaires: a multi-method analysis.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2025Article
- Diagnostic errors in patients admitted directly from new outpatient visits.Diagnosis (Berlin, Germany) · 2025Article
- Article
- Multicriteria Risk Evaluation Model: Utilizing Fuzzy Logic for Improved Transparency and Quality of Risk Evaluation in Healthcare.Risk management and healthcare policy · 2025Article
- Article
- Patient safety reporting and learning system of Catalonia (SNiSP Cat): a health policy initiative to enhance culture, leadership and professional engagement.BMJ open quality · 2024Article
- Patient Safety Incidents in Primary Care: Comparing APEAS-2007 (Spanish Patient Safety Adverse Events Study in Primary Care) with Data from a Health Area in Catalonia (Spain) in 2019.Healthcare (Basel, Switzerland) · 2024Article
- Longitudinal Changes in Diagnostic Accuracy of a Differential Diagnosis List Developed by an AI-Based Symptom Checker: Retrospective Observational Study.JMIR formative research · 2024Article
- Burden of serious harms from diagnostic error in the USA.BMJ quality & safety · 2024Article
- Nurses' perceptions about the patient safety climate in Primary Health Care.Revista latino-americana de enfermagem · 2024Article
Corrections and comments
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Authors and funding
20 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo estimate the incidence of avoidable significant harm in primary care in England; describe and classify the associated patient safety incidents and generate suggestions to mitigate risks of ameliorable factors contributing to the incidents.
designRetrospective case note review. Patients with significant health problems were identified and clinical judgements were made on avoidability and severity of harm. Factors contributing to avoidable harm were identified and recorded.
settingPrimary care.
participantsThirteen general practitioners (GPs) undertook a retrospective case note review of a sample of 14 407 primary care patients registered with 12 randomly selected general practices from three regions in England (total list size: 92 255 patients).
main outcome measuresThe incidence of significant harm considered at least 'probably avoidable' and the nature of the safety incidents.
resultsThe rate of significant harm considered at least probably avoidable was 35.6 (95% CI 23.3 to 48.0) per 100 000 patient-years (57.9, 95% CI 42.2 to 73.7, per 100 000 based on a sensitivity analysis). Overall, 74 cases of avoidable harm were detected, involving 72 patients. Three types of incident accounted for more than 90% of the problems: problems with diagnosis accounted for 45/74 (60.8%) primary incidents, followed by medication-related problems (n=19, 25.7%) and delayed referrals (n=8, 10.8%). In 59 (79.7%) cases, the significant harm could have been identified sooner (n=48) or prevented (n=11) if the GP had taken actions aligned with evidence-based guidelines.
conclusionThere is likely to be a substantial burden of avoidable significant harm attributable to primary care in England with diagnostic error accounting for most harms. Based on the contributory factors we found, improvements could be made through more effective implementation of existing information technology, enhanced team coordination and communication, and greater personal and informational continuity of care.
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