An analysis of general practitioners perspectives on patient safety incidents using critical incident technique interviews

BACKGROUND: General practitioners report difficulty in knowing how to improve patient safety. OBJECTIVES: To analyse general practitioners perspectives of contributing factors to patient safety incidents by collecting accounts of incidents, identifying the contributory factors to these incidents, assessing the impact and likelihood of occurrence of these incidents and examining whether certain categories of contributory factors were associated with the occurrence of high-risk incidents. METHODS: Critical incident technique interviews were carried out with 30 general practitioners in Ireland about a patient safety incident they had experienced. The Yorkshire Contributory Factors Framework was used to classify the contributory factors to incidents. Seven subject matter experts rated the impact and likelihood of occurrence of each incident. RESULTS: A total of 26 interviews were analysed. Almost two-thirds of the patient safety incidents were rated as having a major-to-extreme impact on the patient, and over a third were judged as having at least a bimonthly likelihood of occurrence. The most commonly described active failures were Medication Error (34.6\%) and Diagnostic Error (30.8\%). Situational Domain was identified as a contributory domain in all patient safety incidents. Communication breakdown at both practice and other healthcare-provider interfaces (69.2\%) was also a commonly cited contributory factor. There were no significant differences in the levels of risk associated with the contributory factors. CONCLUSIONS: Critical incident technique interviews support the identification of contributory factors to patient safety incidents. There is a need to explore the use of the resulting data for quality and safety improvement in general practice.