Learning from patient safety incidents involving acutely sick adults in hospital assessment units in England and Wales: a mixed methods analysis for quality improvement.

OBJECTIVE: Six per cent of hospital patients experience a patient safety incident, of which 12% result in severe/fatal outcomes. Acutely sick patients are at heightened risk. Our aim was to identify the most frequently reported incidents in acute medical units and their characteristics. DESIGN: Retrospective mixed methods methodology: (1) an a priori coding process, applying a multi-axial coding framework to incident reports; and, (2) a thematic interpretative analysis of reports. SETTING: Patient safety incident reports (10 years, 2005-2015) collected from the National Reporting and Learning System, which receives reports from hospitals and other care settings across England and Wales. PARTICIPANTS: Reports describing severe harm/death in acute medical unit were identified. MAIN OUTCOME MEASURES: Incident type, contributory factors, outcomes and level of harm were identified in the included reports. During thematic analysis, themes and metathemes were synthesised to inform priorities for quality improvement. RESULTS: A total of 377 reports of severe harm or death were confirmed. The most common incident types were diagnostic errors (n = 79), medication-related errors (n = 61), and failures monitoring patients (n = 57). Incidents commonly stemmed from lack of active decision-making during patient admissions and communication failures between teams. Patients were at heightened risk of unsafe care during handovers and transfers of care. Metathemes included the necessity of patient self-advocacy and a lack of care coordination. CONCLUSION: This 10-year national analysis of incident reports provides recommendations to improve patient safety including: introduction of electronic prescribing and monitoring systems; forcing checklists to reduce diagnostic errors; and increased senior presence overnight and at weekends.

Do members of the British public know how to contact emergency medical services when abroad?

There is increased demand for emergency healthcare by the public when abroad. This study aimed to investigate adults' reported level of knowledge about how to contact emergency healthcare services while abroad. A street survey was administered at various times, over several days, to 554 members of the general public who had been abroad in the previous 18 months. Only 33.6% [95% confidence interval (29.6%-37.7%)] of respondents reported that they knew the emergency medical number for the country last visited. This did not differ by sex (34.2% males vs. 33% females). Those fluent in the language of the country last visited were more likely to report knowing the emergency number for that country (54%), compared with those who were not (24.8%) (P<0.001). It is concerning that the majority of the general public do not appear to know how to contact emergency medical services while abroad. More targeted health education campaigns that address this are needed.