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Patient Safety in Primary Allied Health Care: What Can We Learn From Incidents in a Dutch Exploratory Cohort Study?

van Dulmen, Simone A. PT, MSc; Tacken, Margot A.J.B. PhD; Staal, J. Bart PhD; Gaal, Sander MD; Wensing, Michel PhD; Nijhuis-van der Sanden, Maria W.G. PT, PhD

doi: 10.1097/MLR.0b013e3182367105
Original Articles

Background: Research on patient safety in allied healthcare is scarce. Our aim was to document patient safety in primary allied healthcare in the Netherlands and to identify factors associated with incidents.

Design and Subject: A retrospective study of 1000 patient records in a representative sample of 20 allied healthcare practices was combined with a prospective incident-reporting study.

Measures: All records were reviewed by trained researchers to identify patient safety incidents. The incidents were classified and analyzed, using the Prevention and Recovery Information System for Monitoring and Analysis method. Factors associated with incidents were examined in a logistic regression analysis.

Results: In 18 out of 1000 (1.8%; 95% confidence interval: 1.0–2.6) records an incident was detected. The main causes of incidents were related to errors in clinical decisions (89%), communication with other healthcare providers (67%), and monitoring (56%). The probability of incidents was higher if more care providers had been involved and if patient records were incomplete (37% of the records). No incidents were reported in the prospective study.

Conclusions: The absolute number of incidents was low, which could imply a low risk of harm in Dutch primary allied healthcare. Nevertheless, incompleteness of the patient records and the fact that incidents were mainly caused through human actions suggest that a focus on clinical reasoning and record keeping is needed to further enhance patient safety. Improvements in record keeping will be necessary before accurate incident reporting will be feasible and valid.

Radboud University Nijmegen Medical Centre, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands

The Dutch Ministry of Health, Welfare and Sport initiated the project and supported it financially (without restrictions on the scientific work; grant number 313741).

The authors declare no conflict of interest.

Reprints: Simone A. van Dulmen, MSc, Radboud University Nijmegen Medical Centre, 114 Scientific Institute for Quality of Healthcare, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.