Safety in Primary Care (SAP-C): A randomised, controlled feasibility study in two different healthcare systems

Caoimhe Madden, Sinead Lydon, Margaret Cupples, Nigel Hart, Ciara Curran, Andrew Murphy, Paul O'Connor

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Abstract

Background
Patient safety research is conducted predominantly in hospital settings, with a dearth of insight from primary care, despite suggestions that 2.2% of primary care consultations result in a patient safety incident. This study aimed to assess the feasibility of an intervention intended to improve patient safety in general practice.

Methods
A randomised controlled feasibility study was conducted with general practices in the Republic of Ireland (N = 9) and Northern Ireland (N = 2), randomly assigned to the intervention (N = 5) or control (N = 6) group. The nine-month intervention consisted of: 1) repeated safety climate (SC) measurement (using GP-SafeQuest questionnaire) and feedback (comparative anonymised practice-level SC data), and 2) patient record reviews using a specialised trigger tool to identify instances of undetected patient harm. For control practices, SC was measured at baseline and study end only. The intervention’s perceived usefulness and feasibility were explored via an end-of-study questionnaire and semi-structured interviews.

Results
Thirteen practices were invited; 11 participated; 10 completed the study. At baseline, 84.8% of intervention practice staff (39/46) and 77.8% (42/54) of control practice staff completed the SC questionnaire; at the study terminus, 78.3% (36/46) of intervention practice staff and 68.5% (37/54) of control practice staff did so. Changes in SC scores, indicating improvement, were observed among the intervention practices but not in the control group. The trigger tool was applied to 188 patient records; patient safety incidents of varying severity were detected in 19.1% (36/188). Overall, 59% of intervention practice team members completed the end-of-study questionnaire, with the majority in both healthcare systems responding positively about the intervention. Interviews (N = 9) identified the intervention’s usefulness in informing practice management and patient safety issues, time as a barrier to its use, and the value of group discussion of feedback.

Conclusion
This feasibility study suggests that a definitive randomised controlled trial of the intervention is warranted. Our findings suggest that the intervention is feasible, useful, and sustainable. Practices were willing to be recruited into the study, response and retention rates were acceptable, and there is possible evidence of a positive effect of the intervention.
Original languageEnglish
JournalBMC Family Practice
Volume20
Issue number22
DOIs
Publication statusPublished - 30 Jan 2019

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Feasibility Studies
Primary Health Care
Climate
Patient Safety
Delivery of Health Care
Safety
General Practice
Interviews
Patient Harm
Northern Ireland
Practice Management
Ireland
Referral and Consultation
Randomized Controlled Trials
Control Groups
Surveys and Questionnaires
Research

Cite this

Madden, Caoimhe ; Lydon, Sinead ; Cupples, Margaret ; Hart, Nigel ; Curran, Ciara ; Murphy, Andrew ; O'Connor, Paul. / Safety in Primary Care (SAP-C): A randomised, controlled feasibility study in two different healthcare systems. In: BMC Family Practice. 2019 ; Vol. 20, No. 22.
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title = "Safety in Primary Care (SAP-C): A randomised, controlled feasibility study in two different healthcare systems",
abstract = "BackgroundPatient safety research is conducted predominantly in hospital settings, with a dearth of insight from primary care, despite suggestions that 2.2{\%} of primary care consultations result in a patient safety incident. This study aimed to assess the feasibility of an intervention intended to improve patient safety in general practice.MethodsA randomised controlled feasibility study was conducted with general practices in the Republic of Ireland (N = 9) and Northern Ireland (N = 2), randomly assigned to the intervention (N = 5) or control (N = 6) group. The nine-month intervention consisted of: 1) repeated safety climate (SC) measurement (using GP-SafeQuest questionnaire) and feedback (comparative anonymised practice-level SC data), and 2) patient record reviews using a specialised trigger tool to identify instances of undetected patient harm. For control practices, SC was measured at baseline and study end only. The intervention’s perceived usefulness and feasibility were explored via an end-of-study questionnaire and semi-structured interviews.ResultsThirteen practices were invited; 11 participated; 10 completed the study. At baseline, 84.8{\%} of intervention practice staff (39/46) and 77.8{\%} (42/54) of control practice staff completed the SC questionnaire; at the study terminus, 78.3{\%} (36/46) of intervention practice staff and 68.5{\%} (37/54) of control practice staff did so. Changes in SC scores, indicating improvement, were observed among the intervention practices but not in the control group. The trigger tool was applied to 188 patient records; patient safety incidents of varying severity were detected in 19.1{\%} (36/188). Overall, 59{\%} of intervention practice team members completed the end-of-study questionnaire, with the majority in both healthcare systems responding positively about the intervention. Interviews (N = 9) identified the intervention’s usefulness in informing practice management and patient safety issues, time as a barrier to its use, and the value of group discussion of feedback.ConclusionThis feasibility study suggests that a definitive randomised controlled trial of the intervention is warranted. Our findings suggest that the intervention is feasible, useful, and sustainable. Practices were willing to be recruited into the study, response and retention rates were acceptable, and there is possible evidence of a positive effect of the intervention.",
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Safety in Primary Care (SAP-C): A randomised, controlled feasibility study in two different healthcare systems. / Madden, Caoimhe; Lydon, Sinead; Cupples, Margaret; Hart, Nigel; Curran, Ciara; Murphy, Andrew; O'Connor, Paul.

In: BMC Family Practice, Vol. 20, No. 22, 30.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Safety in Primary Care (SAP-C): A randomised, controlled feasibility study in two different healthcare systems

AU - Madden, Caoimhe

AU - Lydon, Sinead

AU - Cupples, Margaret

AU - Hart, Nigel

AU - Curran, Ciara

AU - Murphy, Andrew

AU - O'Connor, Paul

PY - 2019/1/30

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N2 - BackgroundPatient safety research is conducted predominantly in hospital settings, with a dearth of insight from primary care, despite suggestions that 2.2% of primary care consultations result in a patient safety incident. This study aimed to assess the feasibility of an intervention intended to improve patient safety in general practice.MethodsA randomised controlled feasibility study was conducted with general practices in the Republic of Ireland (N = 9) and Northern Ireland (N = 2), randomly assigned to the intervention (N = 5) or control (N = 6) group. The nine-month intervention consisted of: 1) repeated safety climate (SC) measurement (using GP-SafeQuest questionnaire) and feedback (comparative anonymised practice-level SC data), and 2) patient record reviews using a specialised trigger tool to identify instances of undetected patient harm. For control practices, SC was measured at baseline and study end only. The intervention’s perceived usefulness and feasibility were explored via an end-of-study questionnaire and semi-structured interviews.ResultsThirteen practices were invited; 11 participated; 10 completed the study. At baseline, 84.8% of intervention practice staff (39/46) and 77.8% (42/54) of control practice staff completed the SC questionnaire; at the study terminus, 78.3% (36/46) of intervention practice staff and 68.5% (37/54) of control practice staff did so. Changes in SC scores, indicating improvement, were observed among the intervention practices but not in the control group. The trigger tool was applied to 188 patient records; patient safety incidents of varying severity were detected in 19.1% (36/188). Overall, 59% of intervention practice team members completed the end-of-study questionnaire, with the majority in both healthcare systems responding positively about the intervention. Interviews (N = 9) identified the intervention’s usefulness in informing practice management and patient safety issues, time as a barrier to its use, and the value of group discussion of feedback.ConclusionThis feasibility study suggests that a definitive randomised controlled trial of the intervention is warranted. Our findings suggest that the intervention is feasible, useful, and sustainable. Practices were willing to be recruited into the study, response and retention rates were acceptable, and there is possible evidence of a positive effect of the intervention.

AB - BackgroundPatient safety research is conducted predominantly in hospital settings, with a dearth of insight from primary care, despite suggestions that 2.2% of primary care consultations result in a patient safety incident. This study aimed to assess the feasibility of an intervention intended to improve patient safety in general practice.MethodsA randomised controlled feasibility study was conducted with general practices in the Republic of Ireland (N = 9) and Northern Ireland (N = 2), randomly assigned to the intervention (N = 5) or control (N = 6) group. The nine-month intervention consisted of: 1) repeated safety climate (SC) measurement (using GP-SafeQuest questionnaire) and feedback (comparative anonymised practice-level SC data), and 2) patient record reviews using a specialised trigger tool to identify instances of undetected patient harm. For control practices, SC was measured at baseline and study end only. The intervention’s perceived usefulness and feasibility were explored via an end-of-study questionnaire and semi-structured interviews.ResultsThirteen practices were invited; 11 participated; 10 completed the study. At baseline, 84.8% of intervention practice staff (39/46) and 77.8% (42/54) of control practice staff completed the SC questionnaire; at the study terminus, 78.3% (36/46) of intervention practice staff and 68.5% (37/54) of control practice staff did so. Changes in SC scores, indicating improvement, were observed among the intervention practices but not in the control group. The trigger tool was applied to 188 patient records; patient safety incidents of varying severity were detected in 19.1% (36/188). Overall, 59% of intervention practice team members completed the end-of-study questionnaire, with the majority in both healthcare systems responding positively about the intervention. Interviews (N = 9) identified the intervention’s usefulness in informing practice management and patient safety issues, time as a barrier to its use, and the value of group discussion of feedback.ConclusionThis feasibility study suggests that a definitive randomised controlled trial of the intervention is warranted. Our findings suggest that the intervention is feasible, useful, and sustainable. Practices were willing to be recruited into the study, response and retention rates were acceptable, and there is possible evidence of a positive effect of the intervention.

U2 - 10.1186/s12875-019-0909-8

DO - 10.1186/s12875-019-0909-8

M3 - Article

VL - 20

JO - BMC Family Practice

JF - BMC Family Practice

SN - 1471-2296

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