Skip to content Skip to navigation
University of Warwick
  • Study
  • |
  • Research
  • |
  • Business
  • |
  • Alumni
  • |
  • News
  • |
  • About

University of Warwick
Publications service & WRAP

Highlight your research

  • WRAP
    • Home
    • Search WRAP
    • Browse by Warwick Author
    • Browse WRAP by Year
    • Browse WRAP by Subject
    • Browse WRAP by Department
    • Browse WRAP by Funder
    • Browse Theses by Department
  • Publications Service
    • Home
    • Search Publications Service
    • Browse by Warwick Author
    • Browse Publications service by Year
    • Browse Publications service by Subject
    • Browse Publications service by Department
    • Browse Publications service by Funder
  • Help & Advice
University of Warwick

The Library

  • Login
  • Admin

Learning from diagnostic errors to improve patient safety when GPs work in or alongside emergency departments: incorporating realist methodology into patient safety incident report analysis

Tools
- Tools
+ Tools

Cooper, Alison, Carson-Stevens, Andrew, Cooke, Matthew (Professor of clinical systems design), Hibbert, Peter, Hughes, Thomas, Hussain, Faris, Siriwardena, Aloysius, Snooks, Helen, Donaldson, Liam J. and Edwards, Adrian (2021) Learning from diagnostic errors to improve patient safety when GPs work in or alongside emergency departments: incorporating realist methodology into patient safety incident report analysis. BMC Emergency Medicine, 21 (1). 139. doi:10.1186/s12873-021-00537-w

[img]
Preview
PDF
WRAP-Learning-diagnostic-errors-patients-GPs-emergency-realists-safety-report-2021.pdf - Published Version - Requires a PDF viewer.
Available under License Creative Commons Attribution 4.0.

Download (1759Kb) | Preview
Official URL: https://doi.org/10.1186/s12873-021-00537-w

Request Changes to record.

Abstract

Background: Increasing demand on emergency healthcare systems has prompted introduction of new healthcare service models including the provision of GP services in or alongside emergency departments. In England this led to a policy proposal and £100million (US$130million) of funding for all emergency departments to have co-located GP services. However, there is a lack of evidence for whether such service models are effective and safe. We examined diagnostic errors reported in patient safety incident reports to develop theories to explain how and why they occurred to inform potential priority areas for improvement and inform qualitative data collection at case study sites to further refine the theories. Methods: We used a mixed-methods design using exploratory descriptive analysis to identify the most frequent and harmful sources of diagnostic error and thematic analysis, incorporating realist methodology to refine theories from an earlier rapid realist review, to describe how and why the events occurred and could be mitigated, to inform improvement recommendations. We used two UK data sources: Coroners’ reports to prevent future deaths (30.7.13–14.08.18) and National Reporting and Learning System (NRLS) patient safety incident reports (03.01.05–30.11.15). Results: Nine Coroners’ reports (from 1347 community and hospital reports, 2013–2018) and 217 NRLS reports (from 13 million, 2005–2015) were identified describing diagnostic error related to GP services in or alongside emergency departments. Initial theories to describe potential priority areas for improvement included: difficulty identifying appropriate patients for the GP service; under-investigation and misinterpretation of diagnostic tests; and inadequate communication and referral pathways between the emergency and GP services. High-risk presentations included: musculoskeletal injury, chest pain, headache, calf pain and sick children. Conclusion: Initial theories include the following topics as potential priority areas for improvement interventions and evaluation to minimise the risk of diagnostic errors when GPs work in or alongside emergency departments: a standardised initial assessment with streaming guidance based on local service provision; clinical decision support for high-risk conditions; and standardised computer systems, communication and referral pathways between emergency and GP services. These theories require refinement and testing with qualitative data collection from case study (hospital) sites.

Item Type: Journal Article
Subjects: R Medicine > R Medicine (General)
R Medicine > RA Public aspects of medicine
R Medicine > RC Internal medicine
Divisions: Faculty of Medicine > Warwick Medical School
SWORD Depositor: Library Publications Router
Library of Congress Subject Headings (LCSH): Emergency medical services , Emergency medical services -- Patients -- Safety measures, Hospitals -- Emergency services , Physicians (General practice) , Medical errors -- Prevention
Journal or Publication Title: BMC Emergency Medicine
Publisher: BioMed Central
ISSN: 1471-227X
Official Date: 18 November 2021
Dates:
DateEvent
18 November 2021Published
24 October 2021Accepted
Volume: 21
Number: 1
Article Number: 139
DOI: 10.1186/s12873-021-00537-w
Status: Peer Reviewed
Publication Status: Published
Publisher Statement: ** From Springer Nature via Jisc Publications Router ** History: received 16-04-2021; accepted 24-10-2021; registration 01-11-2021; pub-electronic 18-11-2021; online 18-11-2021; collection 12-2021. ** Licence for this article: http://creativecommons.org/licenses/by/4.0/
Access rights to Published version: Open Access
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
15/145/04National Institute for Health Researchhttp://dx.doi.org/10.13039/501100000272
Related URLs:
  • http://creativecommons.org/licenses/by/4...

Request changes or add full text files to a record

Repository staff actions (login required)

View Item View Item

Downloads

Downloads per month over past year

View more statistics

twitter

Email us: wrap@warwick.ac.uk
Contact Details
About Us