Frequency of Safety Incidents in Primary Care – an Ephemeral Quality

Most epidemiological studies of safety incidents have been done in hospitals, starting with the iconic Harvard Malpractice study.[1] Primary care has proved a more difficult context for quantitative evaluation of safety. A systematic review of reviews and primary studies (109 in total) has recently been published.[2] The main message that I took away is that all estimates are unstable, irrespective of the type of incident (e.g. diagnostic vs. prescribing error), or the quality of the study. Prospective studies seem to detect a higher proportion of incidents than retrospective studies. One important observation is confirmed – diagnostic errors are more likely to result in harm than other types of error – that is why I bang on about diagnostic error.[3]

— Richard Lilford, CLAHRC WM Director


  1. Brennan TA, Leape LL, Laird NM, Hebert L, Localio AR, Lawthers AG, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med. 1991; 324(6): 370-6.
  2. Panesar SS, deSilva D, Carson-Stevens A, et al. How Safe is Primary Care? A Systematic Review. BMJ Qual Saf. 2016; 25: 544-53.
  3. Lilford RJ. Diagnostic Errors – Extremely Important but How Can They Be Measured? NIHR CLAHRC West Midlands News Blog. 26 February 2016.

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