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dc.contributor.authorPayne, R
dc.contributor.authorClarke, A
dc.contributor.authorSwann, N
dc.contributor.authorvan Dael, J
dc.contributor.authorBrenman, N
dc.contributor.authorRosen, R
dc.contributor.authorMackridge, A
dc.contributor.authorMoore, L
dc.contributor.authorKalin, A
dc.contributor.authorLadds, E
dc.contributor.authorHemmings, N
dc.contributor.authorRybczynska-Bunt, S
dc.contributor.authorFaulkner, S
dc.contributor.authorHanson, I
dc.contributor.authorSpitters, S
dc.contributor.authorWieringa, S
dc.contributor.authorDakin, FH
dc.contributor.authorShaw, SE
dc.contributor.authorWherton, J
dc.contributor.authorByng, R
dc.contributor.authorHusain, L
dc.contributor.authorGreenhalgh, T
dc.date.accessioned2024-01-24T11:22:22Z
dc.date.available2024-01-24T11:22:22Z
dc.date.issued2023-11-28
dc.identifier.issn2044-5415
dc.identifier.issn2044-5423
dc.identifier.urihttps://pearl.plymouth.ac.uk/handle/10026.1/21943
dc.description.abstract

Abstract Background Triage and clinical consultations increasingly occur remotely. We aimed to learn why safety incidents occur in remote encounters and how to prevent them.

Setting and sample UK primary care. 95 safety incidents (complaints, settled indemnity claims and reports) involving remote interactions. Separately, 12 general practices followed 2021–2023.

Methods Multimethod qualitative study. We explored causes of real safety incidents retrospectively (‘Safety I’ analysis). In a prospective longitudinal study, we used interviews and ethnographic observation to produce individual, organisational and system-level explanations for why safety and near-miss incidents (rarely) occurred and why they did not occur more often (‘Safety II’ analysis). Data were analysed thematically. An interpretive synthesis of why safety incidents occur, and why they do not occur more often, was refined following member checking with safety experts and lived experience experts.

Results Safety incidents were characterised by inappropriate modality, poor rapport building, inadequate information gathering, limited clinical assessment, inappropriate pathway (eg, wrong algorithm) and inadequate attention to social circumstances. These resulted in missed, inaccurate or delayed diagnoses, underestimation of severity or urgency, delayed referral, incorrect or delayed treatment, poor safety netting and inadequate follow-up. Patients with complex pre-existing conditions, cardiac or abdominal emergencies, vague or generalised symptoms, safeguarding issues, failure to respond to previous treatment or difficulty communicating seemed especially vulnerable. General practices were facing resource constraints, understaffing and high demand. Triage and care pathways were complex, hard to navigate and involved multiple staff. In this context, patient safety often depended on individual staff taking initiative, speaking up or personalising solutions.

Conclusion While safety incidents are extremely rare in remote primary care, deaths and serious harms have resulted. We offer suggestions for patient, staff and system-level mitigations.

dc.format.extentbmjqs-2023-016674-
dc.format.mediumPrint-Electronic
dc.languageen
dc.publisherBMJ
dc.subjectPrimary care
dc.subjectDiagnostic errors
dc.subjectSafety culture
dc.subjectQualitative research
dc.subjectPrehospital care
dc.titlePatient safety in remote primary care encounters: multimethod qualitative study combining Safety I and Safety II analysis
dc.typejournal-article
dc.typeArticle
dc.typeEarly Access
plymouth.author-urlhttps://www.ncbi.nlm.nih.gov/pubmed/38050161
plymouth.publisher-urlhttp://dx.doi.org/10.1136/bmjqs-2023-016674
plymouth.publication-statusPublished online
plymouth.journalBMJ Quality & Safety
dc.identifier.doi10.1136/bmjqs-2023-016674
plymouth.organisational-group|Plymouth
plymouth.organisational-group|Plymouth|Research Groups
plymouth.organisational-group|Plymouth|Faculty of Health
plymouth.organisational-group|Plymouth|Research Groups|Institute of Health and Community
plymouth.organisational-group|Plymouth|Research Groups|Institute of Translational and Stratified Medicine (ITSMED)
plymouth.organisational-group|Plymouth|Research Groups|Institute of Translational and Stratified Medicine (ITSMED)|CCT&PS
plymouth.organisational-group|Plymouth|Users by role
plymouth.organisational-group|Plymouth|Users by role|Academics
plymouth.organisational-group|Plymouth|Faculty of Health|Peninsula Medical School
plymouth.organisational-group|Plymouth|Research Groups|FoH - Community and Primary Care
plymouth.organisational-group|Plymouth|Research Groups|Plymouth Institute of Health and Care Research (PIHR)
plymouth.organisational-group|Plymouth|REF 2028 Researchers by UoA
plymouth.organisational-group|Plymouth|REF 2028 Researchers by UoA|UoA02 Public Health, Health Services and Primary Care
dc.publisher.placeEngland
dcterms.dateAccepted2023-10-31
dc.date.updated2024-01-24T11:22:22Z
dc.rights.embargodate2024-1-27
dc.identifier.eissn2044-5423
rioxxterms.versionofrecord10.1136/bmjqs-2023-016674


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