PRP134: Patient-safety incidents in time of COVID-19 sanitary crisis: a mixed-method study in primary care.

Jean-Pascal Fournier, MD, PhD; Jerome Nguyen, MD, MSc


Context: The COVID-19 pandemic has generated a global health crisis, and an unprecedented rapid reorganization of primary and secondary care. Combining these constraints resulted in increasing risks of unusual patient safety incidents (PSIs). Analyzing these PSIs would be crucial to adapt primary care organization for future potential similar crises.
Objective: Exploring the nature of PSIs in French primary care settings in time of COVID-19 sanitary crisis.
Study Design: Mixed-methods study of patient safety incidents reported by General Practitioners
Setting: A national primary care PSI reporting platform was developed and secured by Nantes University Hospital in early April 2020. The platform was structured following the Royal College of General Physicians' PSI reporting form: i) patient characteristics, ii) incident types and characteristics, iii) mechanisms of the incident and contributing factors, iv) mitigating actions, v) likeliness of incident occurrence in “peace time”.
Population studied: An email was sent on through the national list of GPs members of the National College National des Généralistes Enseignants on April 2020, 28. This email invited GPs to report any PSIs observed after 2020 March, 14 (date of announcement of containment), and that they believed was related to sanitary crisis.
Outcome Measures: Six trained physicians coded reports, using the Patient Safety (PISA) Research Group classification system (Cardiff University), aligned with the WHO International Classification for Patient Safety. Coders used the framework of the Recursive Model of Incident Analysis, to model the sequence of events culminating and contributing to an incident. Incident type, contributory factors, incident outcome and severity of harm were independently coded by two coders. Any uncertainty was discussed with the coding team and an external expert. Analysis involved data coding, processing, iterative generation of data summaries using descriptive statistical and thematic analysis. Protocol was recorded in (NCT04346121) and approved by CNGE ethics committee (200409160).
Results: On May 2020, 29, 120 analyzable PSIs have been reported. Preliminary analyses suggest signals for delayed diagnosis of acute diagnoses (patients not coming to their GPs or emergency services due to COVID-19 infection risk), and delayed diagnosis of ambulatory conditions (with appointments or elective procedures being canceled and not reported).

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