Analysing potential harm in Australian general practice: an incident-monitoring study.

OBJECTIVE: To collect data on incidents of potential or actual harm to general practice patients and to evaluate the possible causes of these incidents.

DESIGN: An observational study of incidents of potential harm based on a modified critical incidents technique. A non-random sample of general practitioners (GPs) anonymously submitted incident reports contemporaneously.

SETTING AND PARTICIPANTS: Australian general practices between October 1993 and June 1995. During the study period, 324 GPs participated at some time.

MAIN OUTCOME MEASURES: GP-reported free-text descriptions of incidents and structured responses for preventability, potential for harm, immediate consequences, predicted long-term outcomes, type of incident, contributing factors, mitigating factors, and additional resource use.

RESULTS: 805 incidents were reported--76% were preventable; 27% had potential for severe harm. No long term harm was predicted for 66% of incidents. Incidents could relate to pharmacological management (51 per 100 incidents), nonpharmacological management (42 per 100 incidents), diagnosis (34 per 100 incidents) or equipment (5 per 100 incidents). The most common contributory factors were poor communication between patients and healthcare professionals and actions of others (23 per 100 incidents each) and errors in judgement (22 per 100 incidents).

CONCLUSION: Human error and preventable system problems were identified. The incident monitoring technique provided useful data which could be applied to incident prevention strategies.