Primary Care Medical Errors Categorized

WASHINGTON -- Researchers have developed a new categorization of medical errors that occur in primary care, based on the self-reporting by primary care physicians. More than 12 times as many people are seen in primary care physicians’ offices as in hospitals.

“This study shows that practicing family physicians report a spectrum of medical errors that is different from the types of medical errors previously identified in hospitals based care,” reported Susan M. Dovey, Ph.D., research analyst at The Robert Graham Center: Policy Studies in Family Practice and Primary Care. “There are important differences between care in hospitals, where most effort has been focused to improve patient safety, and primary care, where most people receive care for most of their health problems.”

The study is published in this week’s Quality and Safety in Health Care. Forty-two family physician members of the AAFP’s National Network for Family Practice and Primary Care Research volunteered to participate in the study. They reported incidents that happened in their practices that fit the study’s definition of “medical error.” The errors were classified and a categorization developed to use for further examination of patient safety issues in primary care.

The definition of medical error used in the study was that of the U.S. Institute of Medicine: “safety is defined as freedom from accidental injury” and “error is defined as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim.” To make the definitional functional in the study setting – the physicians’ offices, the researchers defined it to the participating physicians by explaining: “For this study, please report anything that happened in your own practice that should not have happened, that was not anticipated and that makes you say ‘that should not happen in my practice, and I don’t want it to happen again’. It can be small or large, administrative or clinical – anything that you identify as something to be avoided in the future.”

Two primary categories were identified: “process errors” including administrative mistakes, failure in investigation process, treatment delivery problems, miscommunication and payment system mix ups; and errors that could only be averted by improving providers’ clinical skills and/or knowledge or diverting clinical tasks to clinically trained providers. This category included events such as receptionists failing to make urgent appointment available for acutely ill infants, physicians deciding to discharge patients from the hospital before they were able to function well at home, errors in execution of clinical tasks, misdiagnosis, and wrong treatment decisions. The researchers found that 86.1 percent of reported errors were administrative and 13.9 percent clinical.

“The data highlight the important role of administrative systems, particularly medical record systems, as a source of errors that matter to patients and doctors,” explained Dovey. “Patients are hurt by medical errors in primary care settings and the lessons about medical errors from hospital-based settings cannot be readily applied in primary care settings. The types of errors are different and distinctive from hospital-based errors and the remedies will necessarily have to be different and distinctive also.”

The researchers plan to use and refine the categorization tool and to study medical errors in primary care more extensively. They will use their research as a basis for proposing remedies.