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dc.contributor.authorRees, Philippaen_US
dc.contributor.authorEdwards, Adrianen_US
dc.contributor.authorPowell, Colinen_US
dc.contributor.authorHibbert, Peteren_US
dc.contributor.authorWilliams, Huwen_US
dc.contributor.authorMakeham, Meredithen_US
dc.contributor.authorCarter, Benen_US
dc.contributor.authorLuff, Donnaen_US
dc.contributor.authorParry, Garethen_US
dc.contributor.authorAvery, Anthonyen_US
dc.contributor.authorSheikh, Azizen_US
dc.contributor.authorDonaldson, Liamen_US
dc.contributor.authorCarson-Stevens, Andrewen_US
dc.date.accessioned2017-03-28T23:48:35Z
dc.date.issued2017en_US
dc.identifier.citationRees, P., A. Edwards, C. Powell, P. Hibbert, H. Williams, M. Makeham, B. Carter, et al. 2017. “Patient Safety Incidents Involving Sick Children in Primary Care in England and Wales: A Mixed Methods Analysis.” PLoS Medicine 14 (1): e1002217. doi:10.1371/journal.pmed.1002217. http://dx.doi.org/10.1371/journal.pmed.1002217.en
dc.identifier.issnen
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:31731680
dc.description.abstractBackground: The UK performs poorly relative to other economically developed countries on numerous indicators of care quality for children. The contribution of iatrogenic harm to these outcomes is unclear. As primary care is the first point of healthcare contact for most children, we sought to investigate the safety of care provided to children in this setting. Methods and Findings: We undertook a mixed methods investigation of reports of primary care patient safety incidents involving sick children from England and Wales’ National Reporting and Learning System between 1 January 2005 and 1 December 2013. Two reviewers independently selected relevant incident reports meeting prespecified criteria, and then descriptively analyzed these reports to identify the most frequent and harmful incident types. This was followed by an in-depth thematic analysis of a purposive sample of reports to understand the reasons underpinning incidents. Key candidate areas for strengthening primary care provision and reducing the risks of systems failures were then identified through multidisciplinary discussions. Of 2,191 safety incidents identified from 2,178 reports, 30% (n = 658) were harmful, including 12 deaths and 41 cases of severe harm. The children involved in these incidents had respiratory conditions (n = 387; 18%), injuries (n = 289; 13%), nonspecific signs and symptoms, e.g., fever (n = 281; 13%), and gastrointestinal or genitourinary conditions (n = 268; 12%), among others. Priority areas for improvement included safer systems for medication provision in community pharmacies; triage processes to enable effective and timely assessment, diagnosis, and referral of acutely sick children attending out-of-hours services; and enhanced communication for robust safety netting between professionals and parents. The main limitations of this study result from underreporting of safety incidents and variable data quality. Our findings therefore require further exploration in longitudinal studies utilizing case review methods. Conclusions: This study highlights opportunities to reduce iatrogenic harm and avoidable child deaths. Globally, healthcare systems with primary-care-led models of delivery must now examine their existing practices to determine the prevalence and burden of these priority safety issues, and utilize improvement methods to achieve sustainable improvements in care quality.en
dc.language.isoen_USen
dc.publisherPublic Library of Scienceen
dc.relation.isversionofdoi:10.1371/journal.pmed.1002217en
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC5240916/pdf/en
dash.licenseLAAen_US
dc.subjectMedicine and Health Sciencesen
dc.subjectPediatricsen
dc.subjectHealth Careen
dc.subjectPrimary Careen
dc.subjectEngineering and Technologyen
dc.subjectEquipmenten
dc.subjectTelephonesen
dc.subjectChild Healthen
dc.subjectPublic and Occupational Healthen
dc.subjectPeople and Placesen
dc.subjectPopulation Groupingsen
dc.subjectAge Groupsen
dc.subjectChildrenen
dc.subjectFamiliesen
dc.subjectDiagnostic Medicineen
dc.subjectSigns and Symptomsen
dc.subjectFeversen
dc.subjectPathology and Laboratory Medicineen
dc.subjectCritical Care and Emergency Medicineen
dc.subjectTrauma Medicineen
dc.subjectTraumatic Injuryen
dc.subjectHead Injuryen
dc.subjectPharmaceuticsen
dc.subjectDrug Therapyen
dc.titlePatient Safety Incidents Involving Sick Children in Primary Care in England and Wales: A Mixed Methods Analysisen
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden
dc.relation.journalPLoS Medicineen
dash.depositing.authorLuff, Donnaen_US
dc.date.available2017-03-28T23:48:35Z
dc.identifier.doi10.1371/journal.pmed.1002217*
dash.authorsorderedfalse
dash.contributor.affiliatedLuff, Donna
dash.contributor.affiliatedParry, Gareth
dash.contributor.affiliatedSheikh, Aziz


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