Potential value of patient record review to assess and improve patient safety in general practice: A systematic review

Figures & data

Figure 1. Identification of studies for review.

Table 1. Characteristics of the 15 included studies, which assess the use of patient record review for detecting patient safety incidents in a primary care setting.

Characteristics	References	Number of studies (%)
Study Location^a
Europe	[15,24–31]	9 (60)
North America	[32–34]	3 (20)
Asia	[35,36]	2 (13.3)
South America	[34]	1 (6.6)
New Zealand	[37]	1 (6.6)
Chart review method
Trigger tool/criteria		6 (40)
Trigger review method (10 triggers)	[15,24,25]	3 (20)
36 trigger criteria	[37]	1 (6.7)
9 trigger criteria	[26]	1 (6.7)
23 trigger criteria	[32]	1 (6.7)
Record review using error definition		5 (33.3)
WHO definition	[27–29]	3 (20)
Diagnostic/documentation/management definition	[35,36]	2 (13.3)
Clinical judgement		2 (13.3)
Physician panel judgement	[30]	1 (6.7)
Individual clinician judgement	[31]	1 (6.7)
Record review following patient report of errors		2 (13.3)
Patient interview	[34]	1 (6.7)
Patient survey	[33]	1 (6.7)
Reviewer^a
Physician	[15,24,25,27–30,32–37]	13 (86.7)
Practice nurse	[24,25,32,33,37]	5 (33.3)
Unidentified researcher	[31,34]	2 (13.3)
Trainee GP/medical students	[26,30]	2 (13.3)
Administrator	[15]	1 (6.7)
Pharmacist	[37]	1 (6.7)
Patient sample^a
Random sample	[24,25,27–29,31–33,35–37]	11 (73.3)
High-risk patient group	[15,24,26]	3 (20)
Random sample with specific criteria	[34,37]	2 (13.3)
Consecutive sampling	[30]	1 (6.7)
Deceased	[29]	1 (6.7)

^a Figures do not total to 15 as some studies fit within more than one of the categories.

Table 2. Patient record review method and patient safety incident characteristics of the 15 studies assessing the use of patient chart review for detecting patient safety incidents in a primary care setting.

Method	Study	Quality score	Number of patient safety incidents per 100 records	Types of errors per 100 records^a
Trigger tool	Sears et al. [32]	30	14.2	Medication error = 2.3
	DeWet et al. [24]	25	14.1	Medication/prescribing errors = 4.9 Diagnosis errors = 0.3	Communication errors= 0.8
	DeWet and Bowie [25]	24	12.8	Medication errors = 7.6
	Eggleton and Dovey [37]	22	26.5	Medication errors = 26.5
	McKay et al. [26]	22	15.4	Data not provided
	Bowie et al. [15]	10	UTD	UTD
Error definition	Gaal et al. [27]	19	21.1	Treatment errors = 3.1 Communication = 2.6 Diagnosis = 2.1
	Khoo et al. [35]	19	UTD	Documentation errors = 98 Medication errors = 53.2	Diagnostic errors = 3.6
	Khoo et al. [36]	19	UTD	Intervention group (pre-intervention) Diagnostic error: 4.1 Medication errors: 43.2	Control group (pre-intervention) Diagnostic error: 3.4 Medication errors: 39
				Intervention group (post-intervention) Diagnostic error: 2.5 Medication errors: 25.2	Control group (post-intervention) Diagnostic error: 0.9 Medication errors: 36.7
	Martijn et al. [28]	17	UTD	Data not provided
	Wetzels et al. [29]	14	Living patients: 7.3 Deceased patients: 14.8	Living patients Diagnosis errors: 0.7 Treatment errors: 2.7 Communication errors: 2.7	Deceased patients Diagnostic errors: 3.7 Communication errors: 7.4
Clinical judgement	Smits et al. [30]	21	2.4	Treatment errors = 1.3	Diagnostic errors = 0.5
	Wetzels et al. [31]	13	7.3	Therapeutic errors: 2.7 Communication errors: 2	Diagnostic errors: 0.7
PRR following patient report	Montserrat-Capella et al. [34]	22	UTD	UTD
	Solberg et al. [33]	18	2.3 (‘real clinician errors’)	UTD

Note: UTD: unable to determine.

^a The most commonly identified types of Patient Safety Incidents are presented here. See Supplementary Material 2 for detail on other types of errors.

Figure 2. Severity of identified patient safety incidents per study.

Figure 3. Proportion of patient safety incidents rated as preventable per study.

Bowie P, Halley L, Gillies J, et al. Searching primary care records for predefined triggers may expose latent risks and adverse events. Clinical Risk. 2012;18:13–18.

 Google Scholar

Khoo EM, Lee WK, Sararaks S, et al. Medical errors in primary care clinics-a cross sectional study. BMC Fam Pract. 2012;13:127

 PubMed Web of Science ®Google Scholar

Khoo EM, Sararaks S, Lee WK, et al. Reducing medical errors in primary care using a pragmatic complex intervention. Asia Pac J Public Health. 2015;27:670–677.

 PubMed Web of Science ®Google Scholar

Montserrat-Capella D, Suarez M, Ortiz L, et al. Frequency of ambulatory care adverse events in Latin American countries: the AMBEAS/PAHO cohort study. Int J Qual Health Care. 2015;27:52–59.

 PubMed Web of Science ®Google Scholar

Eggleton KS, Dovey SM. Using triggers in primary care patient records to flag increased adverse event risk and measure patient safety at clinic level. NZ Med J 2014;127:45–52.

 PubMedGoogle Scholar

De Wet C, Black C, Luty S, et al. Implementation of the trigger review method in Scottish general practices: patient safety outcomes and potential for quality improvement. BMJ Qual Saf 2017;26:335–342.

 PubMed Web of Science ®Google Scholar

De Wet C, Bowie P. The preliminary development and testing of a global trigger tool to detect error and patient harm in primary-care records. Postgrad Med J 2009;85:176–180.

 PubMed Web of Science ®Google Scholar

McKay J, de Wet C, Kelly M, et al. Applying the trigger review method after a brief educational intervention: potential for teaching and improving safety in GP specialty training? BMC Med Ed 2013;13:117.

 PubMed Web of Science ®Google Scholar

Sears N, Baker RG, Barnsley J, et al. The incidence of adverse events among home care patients. Int J Qual Health Care 2013;25:16–28.

 PubMed Web of Science ®Google Scholar

Smits M, Huibers L, Kerssemeijer B, et al. Patient safety in out-of-hours primary care: a review of patient records. BMC Health Serv Res. 2010;10:335.

 PubMed Web of Science ®Google Scholar

Wetzels R, Wolters R, van Weel C, et al. Harm caused by adverse events in primary care: a clinical observational study. J Eval Clin Pract. 2009;15:323–327.

 PubMed Web of Science ®Google Scholar

Solberg LI, Asche SE, Averbeck BM, et al. Can patient safety be measured by surveys of patient experiences? J Comm J Qual Patient Saf. 2008;34:266–274.

 PubMedGoogle Scholar

Wetzels R, Wolters R, van Weel C, et al. Mix of methods is needed to identify adverse events in general practice: a prospective observational study. BMC Fam Pract. 2008;9:35.

 PubMed Web of Science ®Google Scholar

Gaal S, Verstappen W, Wolters R, et al. Prevalence and consequences of patient safety incidents in general practice in the Netherlands: a retrospective medical record review study. Implementation Sci 2011;6:37.

 PubMed Web of Science ®Google Scholar

Martijn L, Harmsen M, Gaal S, et al. Are health professionals’. Perceptions of patient safety related to figures on safety incidents? J Eval Clin Pract. 2013;19:944–947.

 PubMed Web of Science ®Google Scholar