Search

Background The UK performs poorly relative to other economically developed countries on numerous indicators of care quality for children. The contribution of iatrogenic harm to these outcomes is unclear. As primary care is the first point of healthcare contact for most children, we sought to investigate the safety of care provided to children in this setting. Methods and Findings We undertook a mixed methods investigation of reports of primary care patient safety incidents involving sick children from England and Wales’ National Reporting and Learning System between 1 January 2005 and 1 December 2013. Two reviewers independently selected relevant incident reports meeting prespecified criteria, and then descriptively analyzed these reports to identify the most frequent and harmful incident types. This was followed by an in-depth thematic analysis of a purposive sample of reports to understand the reasons underpinning incidents. Key candidate areas for strengthening primary care provision and reducing the risks of systems failures were then identified through multidisciplinary discussions. Of 2,191 safety incidents identified from 2,178 reports, 30% (n = 658) were harmful, including 12 deaths and 41 cases of severe harm. The children involved in these incidents had respiratory conditions (n = 387; 18%), injuries (n = 289; 13%), nonspecific signs and symptoms, e.g., fever (n = 281; 13%), and gastrointestinal or genitourinary conditions (n = 268; 12%), among others. Priority areas for improvement included safer systems for medication provision in community pharmacies; triage processes to enable effective and timely assessment, diagnosis, and referral of acutely sick children attending out-of-hours services; and enhanced communication for robust safety netting between professionals and parents. The main limitations of this study result from underreporting of safety incidents and variable data quality. Our findings therefore require further exploration in longitudinal studies utilizing case review methods. Conclusions This study highlights opportunities to reduce iatrogenic harm and avoidable child deaths. Globally, healthcare systems with primary-care-led models of delivery must now examine their existing practices to determine the prevalence and burden of these priority safety issues, and utilize improvement methods to achieve sustainable improvements in care quality., Using a mixed methods approach, Philippa Rees and colleagues describe patient safety incidents involving sick children in primary care in England & Wales., Author Summary Why Was This Study Done? Children receive most of their healthcare in the community setting rather than the hospital setting, but very little is known about the safety of this care. There are signs from previous research that the UK is providing poorer quality pediatric care than its similarly economically developed counterparts. The purpose of this study was to identify what safety concerns there are involving children in primary care, in order to accelerate and inform improvement efforts. What Did the Researchers Do and Find? We analyzed 2,191 reports from a national collection of patient safety incidents that involved sick children in primary care in England and Wales. Of the incidents included in this study, 30% were reported as harmful. Medication errors, particularly in the community pharmacy setting, were commonly reported. Incidents that involved diagnosis, assessment, or referral of sick children were the most harmful of those reported: there were ten deaths, 15 reports of severe harm, and 69 reports of moderate harm. Poor communication underpinned many of the safety incidents reported as harming children. What Do These Findings Mean? It is important to note that our findings are limited by the biased nature of incident report data (not all incidents get reported) and require further studies to confirm them. However, the frequency with which certain incidents are reported clearly points to areas of care requiring improvement. Safer and more reliable medication dispensing systems are needed. Out-of-hours telephone triage systems are not fit for pediatric purpose and require improvement. Mandatory pediatric training for all general practice trainees is essential. We hope that this study acts as an impetus for long-overdue widespread improvement efforts in this area.

PurposePatient safety failures are recognised as a global threat to public health, yet remain a leading cause of death internationally. Vulnerable children are inversely more in need of high-quality primary health and social-care but little is known about the quality of care received. Using national patient safety data, this study aimed to characterise primary care-related safety incidents among vulnerable children.MethodsThis was a cross-sectional mixed methods study of a national database of patient safety incident reports occurring in primary care settings. Free-text incident reports were coded to describe incident types, contributory factors, harm severity and incident outcomes. Subsequent thematic analyses of a purposive sample of reports was undertaken to understand factors underpinning problem areas.ResultsOf 1183 reports identified, 572 (48%) described harm to vulnerable children. Sociodemographic analysis showed that included children had child protection-related (517, 44%); social (353, 30%); psychological (189, 16%) or physical (124, 11%) vulnerabilities. Priority safety issues included: poor recognition of needs and subsequent provision of adequate care; insufficient provider access to accurate information about vulnerable children, and delayed referrals between providers.ConclusionThis is the first national study using incident report data to explore unsafe care amongst vulnerable children. Several system failures affecting vulnerable children are highlighted, many of which pose internationally recognised challenges to providers aiming to deliver safe care to this at-risk cohort. We encourage healthcare organisations globally to build on our findings and explore the safety and reliability of their healthcare systems, in order to sustainably mitigate harm to vulnerable children.