Short report of the panel discussion
Education and Training
Teaching is an important way to start introducing these concepts. Using patients and doctors who could testify of their personal experiences about this is very powerful, patients who have had unsafe experiences and doctors who have experienced a complaint or an error; and let us not forget to use CME/CPD to deepen GPs awareness of the subject.
Measuring Patient Safety
It will be important to gather and assess all the instruments that are available for assessing patient safety (PS) in primary care (PC). There is not 1 instrument that covers all aspects of PS in PC; we need a range of instruments to measure safety in the practice.
Dealing with Uncertainty while Practicing in General Practice
In general practice, patient demand is such that a new patient is seen and their problems are dealt with on average every 6-10 minutes, every day. One of the very unique properties of safety in primary care is working in/dealing with uncertainty, as patients in PC are cared for in a process of longitudinal care which is difficult to relate directly to specific outcomes at a point in time. This makes it different from hospital care and therefor it is essential to look at patient safety in a different way in terms of general practice as it is not appropriate to simply copy what is done in the hospital setting. The agenda for research and action on PS in PC has often been inspired by/driven by (the priorities) of hospital care.
Research in Patient Safety in Primary Care
For future research we can identify some very specific topics for PC: Healthcare is general practice is complex. Patient safety incidents and adverse events are inevitable in every healthcare setting. There is no healthcare facility which is incident free. Can we identify high risk groups and orientate our energy and resources towards these? If we practice with an emphasis on PS how do we prevent over-diagnosis?
Patient Care in the Interface between General Practice and other Care
What about clinical handover and the problems with patient going to and coming back from secondary care? PC is not separate from the rest of the health system and we know a lot of errors occur in these moments the patient is in the interface between systems of care.
Regulations and Legal Aspects of Reporting and Investigating Safety Incidents
What about regulations and a legal framework? That could be a powerful way to realize change. Do we need regulation to change things or is regulation something that endangers quality because it is often (perceived as) extra burden and administration and endangers real quality improvement? Maybe professional bodies (our colleges and societies who are responsible for education and training GPs and CPD) are an alternative way to try to reach GP’s and start a process of change.
But we have to identify medicolegal and defensive medical practices which for the moment make it impossible to work on PS in a constructive way. One area that requires change is to ensure that notification of adverse events can happen in a blame-free context and that the information is used to make the care better, not to punish or have the health professional risk going to court.
Conclusion
The doctor-patient relationship in general practice is the key to improving quality and safety of care. Improving communication in the doctor-patient relationship will help to reconcile the different perspectives of the doctor and the patient on patient safety issues. Also the interface between primary and secondary care is an area that deserves attention in order to reduce harm to patients.
We need to address the issues of high risk patient groups and in particular the negative consequences of over-diagnosis and under-diagnosis in patients. We should ask if we need to re-write research methods for assessing and developing the patient safety culture. We are at the beginning of a structured approach to patient safety in primary care and in this early phase we need to ask what do people think and feel about it, the views of patients and doctors. Then we can go forward.
Report by Piet Vanden Bussche and Andrée Rochfort, EQuiP
Published on 1 July 2016.