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Prevalence and consequences of patient safety incidents in general practice in the Netherlands: a retrospective medical record review study

DOI: 10.1186/1748-5908-6-37

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We conducted a retrospective review of patient records in Dutch general practice. A random sample of 1,000 patients from 20 general practices was obtained. The number of patient safety incidents that occurred in a one-year period, their perceived underlying causes, and impact on patients' health were recorded.We identified 211 patient safety incidents across a period of one year (95% CI: 185 until 241). A variety of types of incidents, perceived causes and consequences were found. A total of 58 patient safety incidents affected patients; seven were associated with hospital admission; none resulted in permanent disability or death.Although this large audit of medical records in general practices identified many patient safety incidents, only a few had a major impact on patients' health. Improving patient safety in this low-risk environment poses specific challenges, given the high numbers of patients and contacts in general practice.Since the publication of the landmark report 'To Err is Human' in 1999 [1], patient safety has received considerable attention worldwide, although this attention has been mostly focussed upon hospital care. In countries with a strong primary healthcare system, such as the Netherlands, patients receive most of their medical care in general practice, but to date adequate data on the prevalence of patient safety incidents in general practice are not available [2,3]. In the Netherlands, all citizens are registered with a personal general practitioner (GP), who provides care for a wide range of medical conditions across an extended period of time. About 95% of all presented health problems, which include many chronic and complex diseases, are managed within the general practice setting [4,5]. As shown by Dutch disciplinary law verdicts, very serious and preventable patient safety incidents also occur in primary care [6].There is no gold standard to identify patient safety incidents [7]. For example, in a pilot study of methods to identify pati


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