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

Figures & data

Figure 1. Examples of codes from the classification system using the Recursive Model of Incident Analysis.

Figure 2. Flow diagram of collected, included and excluded patient safety incident reports. GPs: General Practitioners; CNGE: Collège National des Généralistes Enseignants; PSI: Patient Safety Incident

Table 1. Types of 247 patient safety incidents (132 primary incidents and 115 contributing incidents) described in the 132 reports.

Incidents types^a	Primary incidents^b (n = 132)	All incidents (n = 247)
Diagnosis, assessment & referral	58 (43.9)	96 (38.9)
Diagnosis	45 (34.1)	55 (22.3)
Delayed diagnosis of an emergency condition	18 (13.6)	18 (7.3)
Delay of initial diagnosis of cancer	6 (4.5)	7 (2.8)
Delayed diagnosis (unspecific)	17 (12.9)	18 (7.3)
Other	0 (0.0)	12 (4.9)
Process of assessment	8 (6.1)	27 (10.9)
Delayed assessment	4 (3.0)	9 (3.6)
Errors in the process of identifying patients with acute or serious conditions	3 (2.3)	8 (3.2)
Other	1 (0.8)	10 (4.0)
Incorrect referral	4 (3.0)	10 (4.0)
Other	1 (0.8)	4 (1.6)
Treatment and procedures	43 (32.6)	50 (20.2)
Delayed treatment	22 (16.7)	22 (8.9)
Home confinement complications	13 (9.8)	15 (6.1)
No treatment/care given	6 (4.6)	7 (2.8)
Other	2 (1.6)	6 (2.4)
Investigations	8 (6.1)	28 (11.3)
Diagnostic imaging investigations	3 (2.3)	16 (6.5)
Delayed imaging investigations	1 (0.8)	11 (4.5)
Other	2 (1.6)	5 (2.0)
Laboratory investigations	3 (2.3)	7 (2.8)
Other investigations	2 (1.6)	5 (2.0)
Administrative	3 (2.3)	32 (13.0)
Errors in managing healthcare appointments	1 (0.8)	18 (7.3)
Secondary care appointments	1 (0.8)	15 (6.1)
Other	0 (0.0)	3 (1.2)
Inability to reach out physician	2 (1.6)	7 (2.8)
Incorrect or inefficient transfer of patient information across healthcare systems	0 (0.0)	5 (2.0)
Other	0 (0.0)	2 (0.8)
Medication	16 (12.1)	21 (8.5)
Medication stopped	5 (3.8)	5 (2.0)
Other	11 (8.3)	16 (6.5)
Communication errors	1 (0.8)	15 (6.1)
Between professionals and patients	1 (0.8)	9 (3.6)
Between professionals	0 (0.0)	5 (2.0)
Other	0 (0.0)	1 (0.4)
Other	3 (2.3)	5 (2.0)

^aValues presented as n (%). Primary incidents: incidents chronologically closest to the outcome of the incident for the patient. Contributing incidents: incidents that contributed to the occurrence of another incident.

Table 2. Contributing factors underpinning the 132 primary patient safety incidents.

Contributing factors types^a	Total (n = 263)
Patient factors	163 (62.0)
Pathophysiological factors	91 (34.6)
Previous health/medication history	24 (9.1)
Patient confined at home	18 (6.8)
Physical or mental disability	14 (5.3)
Multimorbidity	8 (3.0)
Child	3 (1.1)
Other	24 (9.1)
Patient and/or relatives’ knowledge	36 (13.7)
Fear of contracting Covid-19 in healthcare facilities	26 (9.9)
Fear of burdening General Practitioner	8 (3.0)
Other	5 (1.9)
Behaviour	13 (4.9)
Age	3 (1.1)
Other	20 (7.6)
Organisational factors	86 (32.7)
Reported or cancelled care due to unavailable or closed services	52 (19.8)
Secondary care consultations	19 (7.2)
Imaging	14 (5.3)
Surgery or procedures cancelled/reported	13 (4.9)
Physiotherapist	8 (3.0)
Laboratory	2 (0.8)
Other	5 (1.9)
Continuity of care	14 (5.3)
Between Secondary and Primary Care	9 (3.4)
Others	5 (1.9)
Working conditions	6 (2.3)
Video-consultations	5 (1.9)
Others	8 (3.0)
Healthcare professional factors	10 (3.8)
Equipment factors	1 (0.4)

^aValues presented as n (%).

Table 3. Types of outcomes of the 132 primary patient safety incidents.

Outcomes types^a	Total (n = 285)^b
Unclear outcome	3 (1.1)
No outcome	14 (4.9)
Healthcare professional identified incident and mitigated outcome	5 (1.7)
Patient, relative or carer identified incident and mitigated outcome	2 (0.7)
Other	7 (2.4)
Patient clinical outcomes	122 (42.8)
Pathophysiological or disease-related outcomes	79 (27.7)
Discomfort/pain	11 (3.9)
General deterioration/progression of condition	25 (8.8)
Other	41 (14.4)
Psychological distress	25 (8.8)
Anxiety	6 (2.1)
Psychological difficulty requiring treatment	6 (2.1)
Other	12 (4.2)
Death	8 (2.8)
Other	10 (3.5)
Patient non-clinical outcomes	124 (43.5)
Delays in management (assessment or treatment)	69 (24.2)
Hospital admission	36 (12.6)
Emergency department or casualty	8 (2.8)
Emergency surgery	8 (2.8)
Hospital admission (unspecific)	20 (7.0)
Additional monitoring required	6 (2.1)
Other	13 (4.6)
Organisational outcomes	13 (4.6)
Primary care staff outcomes	9 (3.2)

a Values presented as n (%).

b Some incidents have generated several outcomes.

Table 4. Harm severity of the 132 primary patient safety incidents.

Harm severity^a	Primary incidents (n = 132)
Unclear harm	33 (25.0)
Unharmful incidents	11 (8.3)
No harm	5 (3.8)
No harm due to mitigating action	6 (4.5)
Harmful incidents	88 (66.7)
Low harm	19 (14.4)
Moderate harm	29 (22.0)
Severe harm	30 (22.7)
Deaths	10 (7.6)

^a Values presented as n (%).

Availability of data and materials

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