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Primary care safety reports on children in England and Wales show areas for improvement

January 17, 2017

An analysis of patient safety incidents involving sick children in England and Wales, published in PLOS Medicine by Dr. Philippa Rees from Cardiff University, UK, and colleagues, reveals areas where primary care providers can improve in their care of children to reduce adverse events.

In the new study, researchers reviewed primary care patient safety reports involving children under age 18 that had been submitted by healthcare professionals to England and Wales' National Reporting and Learning Service between 2003 and 2013. Of the 2191 safety incidents studied, 658 (30%) were harmful, including 12 deaths. Children involved in adverse events were most often being seen for respiratory conditions, including asthma and coughs; injuries, including head and limb injuries and accidental overdoses; and non-specific symptoms, such as fever or weight loss. Primary incident types were dominated by errors in medication (31.9%) -- such as children being prescribed the wrong dose of a drug--and errors in diagnosis and assessment (23.4%), which often led to the delayed management of conditions.

The study is limited by possible under-reporting of some types of safety incidents, but the new analysis led the researchers to identify priority areas for improvement in the care of children, including: safer systems for medication provision in community pharmacies; better triage processes during out-of-hours services; and enhanced communication between professionals and parents.

"Globally, healthcare systems with primary care-led models of delivery must now examine their existing practices to determine the prevalence and burden of these priority safety issues for children," the authors say.

In an accompanying Perspective, Gordon Schiff discusses the challenge of pulling meaningful data from patient safety reports as well as the idea that adverse events being reported are not necessarily representative of all errors occurring. Those challenges notwithstanding, he says the new study "is valuable for both the specific findings, lessons, and insights, but also for encouraging us to grapple with the value of such reporting systems, analysis of collected reports, and ways of better leveraging findings to prevent harm in the future."
Research Article


All co-authors (PR AE CP PH HW MM BC DL GP AA AS LD ACS) are contributing to a project funded by the National Institute for Health Services and Delivery Research Program (project number 12/64/118), The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests:

I have read the journal's policy and the authors of this manuscript have the following competing interests: ACS and AE are co-chief investigators of a National Institute for Health Services and Delivery Research Program grant to characterize patient safety incident reports in primary care. AS is a member of the Editorial Board of PLOS Medicine.


Rees P, Edwards A, Powell C, Hibbert P, Williams H, Makeham M, et al. (2017) Patient Safety Incidents Involving Sick Children in Primary Care in England and Wales: A Mixed Methods Analysis. PLoS Med 14(1): e1002217. doi:10.1371/journal.pmed.1002217

Author Affiliations:

Division of Population Medicine, Cardiff University, Cardiff, United Kingdom
Institute of Child Health, University College London, London, United Kingdom
Australian Institute for Healthcare Innovation, Macquarie University, Macquarie, Australia
Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
Institute for Professionalism and Ethical Practice, Boston Children's Hospital, Boston, Massachusetts, United States of America
Department of Anesthesia, Boston Children's Hospital, Boston, Massachusetts, United States of America
Harvard Medical School, Harvard University, Boston, Massachusetts, United States of America

Institute for Healthcare Improvement, Cambridge, Massachusetts, United States of America
Division of General Practice, University of Nottingham, Nottingham, United Kingdom
Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
Department of Surgery and Cancer, Imperial College London, London, United Kingdom
Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada


Perspective Article


The author received no specific funding for this work.

Competing Interests:

The author has declared that no competing interests exist.


Schiff GD (2017) Sick Children Crying for Help: Fostering Adverse Event Reports. PLoS Med 14(1): e1002216. doi:10.1371/journal.pmed.1002216

Author Affiliations:

Center for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America, Harvard Medical School Center for Primary Care, Boston, Massachusetts, United States of America



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