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Exploring opportunities for improving patient safety when GPs work in or alongside emergency departments: realist synthesis and evaluation

Cooper, Alison 2020. Exploring opportunities for improving patient safety when GPs work in or alongside emergency departments: realist synthesis and evaluation. PhD Thesis, Cardiff University.
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Worldwide, increasing pressure on emergency services has led to the development of different models of care delivery including GPs working in or alongside emergency departments. However, evidence for the effectiveness of this initiative is weak, with a lack of evidence for patient safety outcomes. I aimed to explore the nature of patient safety incidents associated with these service models and how the risks may be mitigated. Method I used realist methodology to understand the relationship between context, mechanisms and outcomes to develop theories about how and why incidents occurred in different settings and how safe care was perceived to be delivered. Data sources included: a rapid realist literature review (synthesis); analysis of a sample of National Reporting and Learning System (NRLS) patient safety incident reports and Coroners’ reports; and qualitative data (‘datix’ reports, observations and semi-structured audio-recorded interviews) from a purposive sample of 13 selected case study sites with different service models. Results There was little evidence in the literature about patient safety outcomes. I identified few incident reports describing diagnostic error associated with these service models: nine Coroners’ reports (9/1347, 2013-2018) and 217 NRLS reports 217/13074550, 2005-2015). These were largely due to: inadequate streaming processes; errors in clinical decision-making or inadequate skillset; xiii and inadequate referral pathways and communication between services. Strategies perceived to facilitate the delivery of safe patient care at selected case sites included: an experienced streaming nurse using local guidance and early warning scores; support for GPs’ clinical decision-making relevant to the intended role (a traditional GP approach or an emergency medicine approach); strong clinical leadership and clear governance processes. These findings have been used to develop a potential intervention to understand how local context influences service set-up, function and resultant outcomes, with associated potential measures and training resources, to facilitate GP services delivering safe patient care in emergency department settings. Conclusion There are few evidence-based interventions to improve patient safety for these service models. Priority areas to focus upon include: appropriate streaming processes; supporting GPs’ clinical decision-making with clear governance processes; and improving communication between services.

Item Type: Thesis (PhD)
Date Type: Completion
Status: Unpublished
Schools: Medicine
Subjects: R Medicine > R Medicine (General)
R Medicine > RA Public aspects of medicine
Date of First Compliant Deposit: 16 November 2020
Last Modified: 16 Nov 2021 02:30

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