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Better IT could reduce significant harm in general practice, study finds

by Emma Wilkinson
11 November 2020

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Better use of IT systems and more continuity of care could help reduce cases of ‘avoidable significant harm’ such as missed diagnosis or medication errors in general practice, a large study has found.

The Government-funded analysis of incidents in 12 randomly selected GP practices covering more than 90,000 patients found 74 cases of avoidable harm in 72 patients after detailed reviews of those with new significant health problems.

It equates to between 20,000 and 32,000 cases of significant harm to patients each year that are probably avoidable, or 3-4 cases per year for an average general practice, the University of Nottingham researchers calculated.

In 97% of patients presenting with significant health problems the researchers found no evidence that these were avoidable.

But it does show a ‘substantial burden’ of significant avoidable harm and it was important to look at where improvements could be made, they concluded in BMJ Quality and Safety.

Speaking with Pulse, study lead Professor Tony Avery, a GP and Professor of Primary Health Care, said patient safety was usually assessed with relation to hospital care and this was the first study to look in detail at primary care clinical records.

He said diagnostic error accounted for 60.8% of the incidents they found, 25.7% related to medication and 10.8% were because of delayed referral.

Many of the cases, including missed cancer diagnoses, were in complex patients with multiple co-morbidities highlighting the challenges that all clinicians in primary care face in keeping patients safe, he added.

And while continuity of care may be a controversial topic they found it had an important role, he said.

‘Our study did pick up examples of people who were seeing one patient after another and not really picking up what was there in the records.

‘I’m not suggesting we go back to personal lists in modern healthcare but it does make a lot of sense for complex patients to principally be seen by one or two doctors.’

The team also noted that some of the cases of avoidable significant harm were linked to GPs having too many problems to deal with in a single consultation.

And they concluded that more effective implementation of existing IT systems could help ensure referrals or investigations are not missed.

In two cases patients had ended up with kidney injury after long-term prescriptions for medication where regular monitoring should have been in place but wasn’t.

RCGP chair Professor Martin Marshall said practices deliver care to around one million patients every single day, and patients should be reassured by this research showing that errors are rare.

‘GPs work exceptionally hard, in very difficult circumstances, to ensure the right clinical decisions are made. But of course they are human so occasionally errors can and do happen’.

He added the College was supportive of any resources or innovation that are designed to help minimise the risks of making avoidable errors.

‘It’s also important to recognise and address the root cause of why, although rare, mistakes do happen in general practice.

‘For example, GPs are working under intense resource and workforce pressures – this was the case before the Covid-19 pandemic, and it continues to be so.

‘It is vital that general practice receives the necessary resources and support to ensure patients continue to receive high-quality, safe care.’

Time and resources

Dr Richard Vautrey, chair of the BMA GP committee, said: ‘Avoidable harm to patients is always deeply regrettable and is something clinicians have deep concerns about. The important issues raised in this report, while being a small number, are no less devastating for patients who suffer as a result of them.

‘It is vital that the medical profession and the wider system learn from them, but the study also highlights how far we have come since it was carried out. These include improvements to avoid medication errors which now involve clinical pharmacists in GP practices working closely with community pharmacists and instigating structured medication reviews for patients with multi morbidity.

‘But it is also important that GPs and their teams are given the time and resources so they can offer the best care for patients, particularly those with increasingly complex health needs. This includes longer consultations, improving continuity of care and clear and effective pathways for referral to secondary care.

‘The improvements to GP funding and the expansion of the primary care workforce, that have taken place in the years since the period covered by the study, are important steps in ensuring incidents like this are minimised.’

‘But it is vital that we continue to learn from any untoward incidents and ensure that we support practices to continual improvement in the care we offer for all our patients.’

This article first appeared on our sister title Pulse.