![]() CADYA (Additional file 1: Appendix S1), which can be translated as Categorization of Errors in Primary Care, is a French taxonomy that provides a complementary approach by describing more accurately the factors contributing to PSIs, especially the human factors, as suggested by research in aeronautics. The Tempos classification uses time in classifying factors contributing to incidents according to five categories: the tempo of illness and treatment, the tempo of the physician, the tempo of the office, the tempo of the patient and the tempo of the health system. The TAPS Taxonomy describes the nature of the incident according to 2 main types of errors: errors related to the care process with 5 sublevels and errors of knowledge or skills of the actors with 2 sublevels (diagnosis and patient management). The first results of the French national survey on PSIs in primary care (ESPRIT) study were based on the Threats to Australian Patient Safety (TAPS) version of the International Taxonomy of Medical Error in Primary Care (ITME-PC) and the Tempos classification. The World Health Organization (WHO) classification is the most universal, but the consequent number of items that compose this taxonomy limits its current use. To classify PSIs, several taxonomies, both specific and not specific to primary care, exist. PSIs in the primary care setting significantly differ from those in hospitals regarding their contributing factors. In France, two prospective studies have estimated the frequency of PSIs in primary care to be between 0.5 and 1 event per day per general practitioner (GP). ![]() The wide range in PSI frequencies can be explained by the type of study (prospective or retrospective), the data collection methods, the multiple proposed definitions of PSIs and the trend of underreporting. In 2007, the frequency of PSIs in primary care was estimated to be from 2 to 240 incidents per 1000 encounters, and 45–76% were considered to be preventable. Fifteen years ago, the report ‘To err is human’ led to an international awareness of the frequency and gravity of PSIs. Patient safety incidents (PSIs) have been reported in primary care under various names. Further research exploring the links between working conditions and human factors is required. Beyond the identification of communication errors, often found in other international research, we have described the attitudes and behaviours contributing to unsafe care. Our results tend to prove that human factors are often involved in PSIs in primary care, with GPs and patients being equally responsible. The human factors were mainly related to ‘lack of attention’, ‘stress’, ‘anger’ and ‘fatigue’. The contributing factors, in decreasing order of frequency, were communication errors (13.7%), human factors related to healthcare providers (12.9%) and human factors related to patients (12.9%). Overall, 35% were related to the care process, 30% to human factors, 22% to the healthcare environment and 13% to technical factors. ResultsĪmong the 482 PSIs reported in the ESPRIT study, from 13,438 acts reported by 127 participating general practitioners (GPs), we identified 590 contributing factors (482 MDs and 178 SDs). A descriptive statistical analysis was then conducted. ![]() Several descriptive keywords from an incremental glossary have been suggested to describe each identified human factor (attitudes or behaviours). For each incident, a main contributing factor (MD) and, if applicable, a secondary contributing factor (SD) were identified. ![]() We followed a mixed method with content analysis and coding in CADYA of PSIs reported in the ESPRIT study, a French cross-sectional survey of primary care. The aim of this work was to describe the underlying factors, specifically the human factors, that are associated with PSIs in primary care using CADYA (“CAtégorisation des DYsfonctionnements en Ambulatoire” or “Categorization of Errors in Primary Care”). Better knowledge of factors contributing to PSIs is required to build safer care. Patient safety incidents (PSIs) frequently occur in primary care and are often considered to be preventable. ![]()
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