Background
Methods
ESPRIT study’s methodological aspects
Data collection method
Ethical aspects
Work methodological aspects
Recruiting coders
Coding process
Statistical analysis
Results
Main ESPRIT study results [5]
Variables | Answers | French National Data | ESPRIT study data (%) | p-value |
---|---|---|---|---|
Gender | Men Women | 66% 34% | 60% 40% | NS |
Average act per week | 102 | 100 | NS | |
Average age | 51 years | 54 years | < 0.05 | |
Mode of practice | Solo Group practice | 52% 48% | 40% 60% | < 0,05 |
Area of practice | Rural Urban | 15% 85% | 17% 83% | < 0,05 |
General data
Frequency and nature of contributing factors
Dimensions | Main contributing factor n (% of MD) | Secondary contributing factor n (% of SD) | Total contributing factor n (% of TD) |
---|---|---|---|
ENVIRONMENTAL FACTORS | 93 (22.8) | 37 (20.3) | 130 (22) |
PATIENT’S SOCIAL CONTEXT | 5 (1.2) | 5 (2.7) | 10 (1.7) |
BACKGROUND OF CARE | 38 (9.3) | 20 (11) | 58 (9.8) |
Unplanned consultation | 10 (2.4) | 0 (0) | 10 (1.7) |
Place of care | 6 (1.5) | 8 (4.4) | 14 (2.4) |
Workload management | 22 (5.4) | 12 (6.6) | 34 (5.7) |
DISRUPTIVE ELEMENT | 27 (6.6) | 7 (3.9) | 34 (5.7) |
HEALTH SYSTEM | 23 (5.7) | 5 (2.7) | 28 (4.7) |
Healthcare service | 20 (5) | 2 (1) | 22 (3.7) |
Financial or administrative issue | 3 (0.7) | 3 (1.7) | 6 (1) |
HUMAN FACTORS | 89 (21.8) | 86 (47.3) | 175 (29.7) |
LINKED TO THE PATIENT | 45 (11) | 31 (17) | 76 (12.9) |
LINKED TO THE PROVIDER | 35 (8.6) | 41 (22.5) | 76 (12.9) |
LINKED TO OTHER PROVIDERS | 4 (1) | 7 (3.9) | 11 (1.9) |
LINKED TO A THIRD PARTY | 5 (1.2) | 7 (3.9) | 12 (2) |
TECHNICAL FACTORS | 67 (16.4) | 9 (4.9) | 76 (12.9) |
EQUIPMENT | 21(5.2) | 2 (1) | 23 (3.9) |
Failure, malfunction, unavailability | 19 (4.7) | 1 (0.5) | 20 (3.4) |
Incorrect use | 2 (0.5) | 1 (0.5) | 3 (0.5) |
INFORMATION SYSTEM | 46 (11.3) | 7 (3.9) | 53 (8.9) |
Incorrect or missing data | 34 (8.3) | 4 (2.2) | 38 (6.4) |
Failure of the communication system | 12 (3) | 3 (1.7) | 15 (2.5) |
PROCESS OF CARE | 159 (39) | 50 (27.5) | 209 (35.4) |
COGNITIVE DIMENSION | 56 (13.8) | 9 (5) | 65 (11) |
Lack in initial training | 26 (6.4) | 3 (1.7) | 29 (4.9) |
Incorrect recall (after training) | 13 (3.2) | 2 (1) | 15 (2.5) |
Incorrect synthesis | 17 (4.2) | 4 (2.2) | 21 (3.6) |
CARE PROCEDURE | 34 (8.3) | 14 (7.7) | 48 (8.1) |
Inappropriate or unachieved procedure | 31 (7.6) | 13 (7.1) | 44 (7.5) |
Lack of protocol | 3 (0.7) | 1 (0.6) | 4 (0.6) |
CARE COORDINATION | 69 (16.9) | 27 (14.8) | 96 (16.3) |
Communication failure | 59 (14.5) | 22 (12.1) | 81 (13.7) |
Lack of (or incorrect) monitoring | 9 (2.2) | 5 (2.7) | 14 (2.4) |
Lack of response after feedback | 1 (0.2) | 0 (0) | 1 (0.2) |
TOTAL | 408 (100) | 182 (100) | 590 (100) |
Item | Examples of patient safety incidents (in the ESPRIT study) |
---|---|
ENVIRONMENTAL FACTORS | |
Patient’s social context | Elderly, suffering from dementia, unsuitable assistance plan |
Background of care | |
Unplanned consultation | A woman took an appointment just for herself and came with her son |
Place of care | Incomplete medical examination because the patient was seen at home |
Workload management | Workload increased by adding too many consultations |
Disruptive element | Phone call caused the physician to dismiss his patient |
Health system | |
Healthcare service | A medical specialist was required but unavailable on weekends |
Financial or administrative issue | No general practitioner declared to social security |
HUMAN FACTORS | |
Linked to the patient | Aggressive patient (who felt rejected by her physician) |
Linked to the provider | Stressed physician (bad news needed to be announced) |
Linked to other providers | Pharmacist distracted when dispensing treatment |
Linked to a third party | Indiscretion of the mother of a patient regarding her daughter |
TECHNICAL FACTORS | |
Equipment | |
Failure, malfunction, unavailability | Failure of the computer server |
Incorrect use | Wound following the inappropriate use of pedicure equipment |
Information system | |
Incorrect or missing data | Lack of discharge letter after hospitalization of a patient |
Failure of the communication system | Ultrasound result was unreadable over the internet |
PROCESS OF CARE | |
Cognitive dimension | |
Lack of initial training | Ignorance of drug contraindication |
Incorrect recall (after training) | Insufficient exploration of thromboembolic risk |
Wrong synthesis | Minimization of a chronic kidney disease |
Care procedure | |
Inappropriate or unachieved procedure | Coronary patient who stopped the statin on her own |
Lack of protocol | Medical appointment for an emergency assigned too late by the secretary |
Care coordination | |
Communication failure | The nurse did not call the physician despite an unusual dosage |
Lack of (or incorrect) monitoring | Lack of specialized ophthalmic monitoring despite serious uveitis |
Lack of response after feedback | Diabetes mellitus non-equilibrated, without medical appointment, for several months despite several blood tests |
Analysis of main contributing factors (Fig. 3)
Secondary contributing factors (Fig. 4)
Nature of human factors
KEYWORDS AFTER SEMANTIC WORK | KEYWORDS IN THE STUDY | GLOBAL FREQUENCY OF USE IN GLOSSARY (% of all tags) |
---|---|---|
LACK OF ATTENTION | Lack of attention, Lapse in concentration, Absent-mindedness | 27.5 |
STRESS | Anxiety, Stress, Anguish, Fear | 15.5 |
LACK OF INVOLVEMENT | Lack of medical observance, Non-involvement, Refusing care, Lag (to consult), Lack of active listening | 10.3 |
NERVOUSNESS | Anger, Irritation, Violence, Aggressiveness | 8 |
TIREDNESS | Tiredness, Asthenia | 5.7 |
IMPRUDENCE | Negligence, Clumsiness | 5.1 |
COMPLEX OR DIFFICULT PERSON | Grouchy, Child-King, Claims | 3.4 |
ADDICTIVE DISORDER | Addictive disorder | 2.9 |
PRIDE | Self-love, Pride, Overconfidence, Vanity | 2.9 |
LACK OF AUTHORITY | Lack of authority, Lack of bravery | 2.2 |
MISUNDERSTANDING | Confusion, Misunderstanding | 2.2 |
SHAME | Shame, Inconvenience, Shyness | 1.7 |
PSYCHOLOGICAL DISORDERS | Psychological disorders | 1.1 |
OVERLY SYMPATHETIC | Sympathetic, Overly empathic | 1.1 |
IMPATIENCE | Impatience, Precipitation | 1.1 |
OTHER WORDS | Falsehood, Medical nomadism, Impairment, Indiscretion, Meticulousness, Verbal comprehension issue, Personal emergency, Recklessness, Abusive request, Lack of collegiality | 9.3 |
TOTAL (%) | 100 |