… or chronic health conditions. … Morris RL, Giles S, Campbell S. Involving patients and carers in patient safety …

Research into patient safety culture in primary dental care remains limited. This commentary provides an overview of patient safety in dentistry and tools to develop a robust patient safety culture, including human factors and supporting second victims.

Medication errors represent a significant source of preventable harm. This large meta-analysis, including 81 studies, found that approximately 1 in 30 patients is exposed to preventable medication harm, and more than one-quarter of this harm is considered severe or life-threatening. Preventable medication harm occurred most frequently during medication prescribing and monitoring. The highest rates of preventable medication harm were seen in elderly patient care settings, intensive care, highly specialized or surgical care, and emergency medicine.

The COVID-19 pandemic has led to patients delaying or forgoing necessary health care, which can contribute to diagnostic and treatment delays.  This retrospective cohort study used primary care data to investigate the indirect effect of the COVID-19 pandemic on primary care health care use and subsequent diagnoses among residents in a poor, urban area in the United Kingdom. Between March and May 2020, there was a 50% reduction in expected diagnoses for mental health conditions, as well as substantial decreases in diagnoses and associated medication prescriptions for circulatory system diseases and type 2 diabetes.  

To better understand patient safety issues of marginalized groups, this scoping review assessed 67 articles primarily focusing on four patient groups: ethnic minorities, frail elderly, care home residents and those with low socioeconomic status. A variety of patient safety issues were identified, and half of the included studies looked at either medication safety, adverse outcomes, and near misses. This review highlights the need for additional research to understand the intersection between marginalization and the multi-dimensional nature of patient safety issues.

"Never events" are serious but generally preventable patient safety incidents. This study surveyed general practitioners in the UK to assess the incidence of specific never-events in those practices, and whether practitioners agreed with the specific events being designated as a never-event. The most commonly reported events were not investigating abnormal test results (45% of practices) and prescribing despite documented adverse reactions (65% of practices); however, these events were also less likely to be designated "never events" by respondents.

Most patient safety research has focused on tertiary care or specialty care settings, but less is known about safety in primary care settings and there is no clear definition of patient safety incidents and harm occurring in these settings.  The authors convened a panel of family physicians and used a consensus method to define “avoidable harm” within family practice. Most scenarios found to be avoidable and included in the proposed definition involved failure to adhere to evidence-based practice guidelines, lack of timely intervention, or failure in administrative processes, such as referrals or procedures for following up on results.

The extent of harm due to patient safety problems varies across studies. This systematic review sought to estimate the prevalence of preventable harm in medical care overall. Researchers synthesized data from 70 studies and estimated that 6% of patients receiving medical care experience preventable harm. Harm related to medications, diagnosis, health care–associated infections, and procedures accounted for significant proportions of preventable harm. The authors conclude that focusing on evidenced-based strategies to address preventable patient harm would improve health care quality and subsequently reduce costs. A related editorial calls for improving measurement of preventable harm. Another editorial spotlights the importance of understanding the causes of preventable harm in health care.

Adverse events reported by patients are often different and more expansive than safety hazards identified by health care providers. Researchers elicited adverse events from a nationally representative sample of British outpatients. About 8% of patients reported an adverse event, which were frequently problems with medications, accessing care in a timely way, and diagnostic errors.

Researchers implemented a multicomponent patient safety toolkit designed to help outpatient practices in England provide safer care. They subsequently interviewed staff to better understand their perspective regarding the toolkit's value as well as barriers to its use.

A recent commentary described fear of uncertainty as a contributor to diagnostic error. This systematic review developed a framework for how primary care clinicians manage uncertainty, consisting of cognitive, emotional, and ethical domains. However, the review identified little data on best ways to support clinicians in handling uncertainty.

Despite increasing focus on diagnostic error, it remains a controversial patient safety issue. The Institute of Medicine recently suggested that further research is needed regarding electronic tools to improve diagnosis. Differential diagnosis generators provide a list of possible diagnoses for a problem. The investigators conducted a systematic review and found that differential diagnosis generators have been shown to improve diagnostic accuracy when a clinician has an opportunity to re-review the case using the software in pre-post studies. The degree of improvement varied between studies. The effect on actual clinician behaviors—such as test ordering, clinical outcomes, and cost—is unclear. Clinicians need prospective studies in order to determine whether such tools enhance diagnosis in actual practice. A recent PSNet perspective discussed future research avenues to ensure progress in diagnostic safety.

This sociology study used qualitative interviews with primary care patients to explore their conceptualization of patient safety. The patients provided multiple insights that suggested they might feel more equipped to be proactive about ensuring their safety in primary care compared to the less predictable hospital setting.

This systematic review of patient safety in dentistry found scant evidence for effective patient safety approaches, with the exception of surgical safety checklists, which were successful in preventing wrong tooth extractions. Further research is needed to characterize patient safety in dentistry and implement effective interventions.

Although the field of patient safety was largely built around a systems approach, this interview-based qualitative study in England sought to understand how patients perceive safety in primary care. Researchers determined that ambulatory patients focus on individual trust and relationships when thinking about safety. Patients were not able to clearly differentiate dimensions of safety from quality, suggesting that in real-world experiences these domains are considered similar. Some of the important markers of safe care, according to patients, were prompt investigations and referrals to specialists. The authors note that none of the patients interviewed in this study mentioned unnecessary care as a cause of concern. Patient safety researcher Dr. Urmimala Sarkar discussed patient safety in the ambulatory setting in a recent AHRQ WebM&M interview.

Proven methods to track progress in ambulatory care safety are lacking. This review explores what is known about monitoring errors in family practice and highlights tools available to measure safety in primary care to inform the development of an evidence-based patient safety toolkit for use in this setting.

This qualitative study conducted with focus groups of British general practitioners identified four potential unintended consequences of new quality measures: measure fixation (overemphasis of specific aspects of care), tunnel vision (missing important contextual information due to focusing on measures), misinterpretation of metrics, and potential for gaming measurements to inflate achievement.

This study surveyed providers in British general practices and found no significant association between elements of organizational culture and quality of care.