Patient-safety incidents during COVID-19 health crisis in France: An exploratory sequential multi-method study in primary care

Abstract

Background

The COVID-19 pandemic has resulted in the rapid reorganisation of health and social care services. Patients are already at significant risk of healthcare-associated harm and the wholesale disruption to service delivery during the pandemic stood to heighten those risks.

Objectives

We explored the type and nature of patient safety incidents in French primary care settings during the COVID-19 first wave to make tentative recommendations for improvement.

Methods

A national patient safety incident reporting survey was distributed to General Practitioners (GPs) in France on 28 April 2020. Reports were coded using a classification system aligned to the WHO International Classification for Patient Safety (incident types, contributing factors, incident outcomes and severity of harm). Analysis involved data coding, processing, iterative generation of data summaries using descriptive statistical analysis. Clinicaltrials.gov: NCT04346121.

Results

Of 132 incidents, 58 (44%) related to delayed diagnosis, assessments and referrals. Cancellations of appointments, hospitalisations or procedures was reported in 22 (17%) of these incidents. Home confinement-related incidents accounted for 13 (10%) reports and inappropriate medication stopping for five (4%). Patients delayed attending or did not consult their general practitioner or other healthcare providers due to their fear of contracting COVID-19 infection at an in-person visit in 26 (10%) incidents or fear of burdening their GPs in eight (3%) incidents.

Conclusion

Constraints from the first wave of the COVID-19 pandemic have contributed to patient safety incidents during non-COVID-19 care. Lessons from these incidents pinpoint where primary care services in France can focus resources to design safer systems for patients.

Keywords:

• Patient safety incident
• primary care
• COVID-19
• lockdown

Acknowledgements

The authors received assistance with the design of the reporting platform from Nantes University Hospital. In addition, the authors thank the Collège National des Généralistes Enseignants (CNGE) for their help in data collection, Tanguy Roman for his help in designing the reporting platform and primary data extraction and Stuart Hellard for his service in the management of the PISA platform.

Authors’ contributions

JPF and ACS were involved in the conception of the study. JPF, SH, JNS, JBA, BS, and AD were involved in the data collection. JPF, SH, JNS, JBA, BS, AD, PB and ACS were involved in the data analysis. JPF, SH, JNS, JBA, BS, AD, PB, LD and ACS were involved in the data interpretation. JPF drafted the first version of the manuscript. JPF, SH, JNS, JBA, BS, AD, PB, LD and ACS read and approved the final manuscript.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Availability of data and materials

JPF can be contacted for access to the dataset underlying the current analysis.