Practice management

Improving patient safety during remote encounters

• A multimethod qualitative study explored the cause of 95 safety incidents that occurred across 12 general practices during remote encounters (triage and consultations) between 2021-2023.

• Remote clinical assessment provided less information when a physical examination (or being in the same room as the patient) was not possible.

• Safety incidents were characterised by inappropriate modality, poor rapport building, inadequate information gathering, limited clinical assessment, inappropriate pathway (eg, wrong algorithm) and inadequate attention to social circumstances.

• These resulted in missed, inaccurate or delayed diagnoses, underestimation of severity or urgency, delayed referral, incorrect or delayed treatment, poor safety netting and inadequate follow-up.

• Patients with complex pre-existing conditions, cardiac or abdominal emergencies, vague or generalised symptoms, safeguarding issues, failure to respond to previous treatment or difficulty communicating were especially vulnerable.

• Patient safety often depended on individual staff taking initiative, speaking up or personalising solutions.

WiseGP Actions

1. Review the patient safety incidents involving harm/ death and examples of safety practices that helped to avoid harm in the article (link below).

   What lessons can you take from them to share with your team?

2. Arrange a practice meeting to review Table 2 in the article with your team. This includes a list of patient, staff and system-level approaches to reduce patient safety incidents.

   How could it inform the design of your practice triage system?

   What changes could you apply to your practice to improve safety?

Read more about the research informing this GEM here: https://qualitysafety.bmj.com/content/33/9/573.long