Features: Prioritising patient safety
25 March 2009
A GP explains a new approach for detecting adverse events in patient care in general practice.
Dr Robert Varnam, a GP in Manchester, joined the NHS Institute for Innovation and Improvement’s Safer Care programme, to help understand and improve patient safety in general practice. Here he explains a new approach for detecting adverse events in patient care in general practice.
Despite all our efforts and good intentions, patients can suffer complications while under our care. The same is true in healthcare systems the world over. I’ve been an enthusiast for patient safety for several years, but it’s only recently that I’ve felt the need to find new ways to measure and improve the safety of care in general practice.
I lead Significant Event Audit (SEA) activity for a large, multidisciplinary team. We've always had a healthy approach to shared learning, which has allowed SEA to fit easily into our regular team meetings. Resources such as the SEA Toolkit and the Manchester Patient Safety Framework (available at www.npsa.nhs.uk) have helped us understand more about the causes of adverse events and the considerable influence of factors outside the individual clinician.
Some of our SEAs have involved the analysis of whole systems of care in the practice and led to far-reaching changes in the way we do things. In the past two years we have undertaken 21 such analyses, with a long list of resultant ‘action points’.
But have we reduced harm for our patients? We don't know. There are too few significant event reports to provide a useful denominator against which to quantify the effects of our efforts to improve. Unlike hospital care, general practice has not routinely used metrics of harm to track changes over time.
It was therefore not a difficult decision to accept an offer to work with the NHS Institute for Innovation and Improvement’s Safer Care team, helping to develop a means of measuring the incidence of adverse events in general practice.
The Global Trigger Tool we are currently testing is a proactive casenote review approach to detecting and counting adverse events. We are working with 43 GPs around England, who are testing the tool in practice in order for us to refine it later this year. I'm hopeful that before too long, GPs throughout the country will be able to use it to identify the areas where most harm arises and measure the effects of their efforts to improve patient safety.
GPs interested in our work can find out more at www.institute.nhs.uk/safercare.