Skip to main content
PMC home page
Quality & Safety in Health Care logoLink to Quality & Safety in Health Care
. 2002 Sep;11(3):233–238. doi: 10.1136/qhc.11.3.233

A preliminary taxonomy of medical errors in family practice

S Dovey 1, D Meyers 1, R Phillips 1, L Green 1, G Fryer 1, J Galliher 1, J Kappus 1, P Grob 1
PMCID: PMC1743626  PMID: 12486987

Abstract

Objective: To develop a preliminary taxonomy of primary care medical errors.

Design: Qualitative analysis to identify categories of error reported during a randomized controlled trial of computer and paper reporting methods.

Setting: The National Network for Family Practice and Primary Care Research.

Participants: Family physicians.

Main outcome measures: Medical error category, context, and consequence.

Results: Forty two physicians made 344 reports: 284 (82.6%) arose from healthcare systems dysfunction; 46 (13.4%) were errors due to gaps in knowledge or skills; and 14 (4.1%) were reports of adverse events, not errors. The main subcategories were: administrative failures (102; 30.9% of errors), investigation failures (82; 24.8%), treatment delivery lapses (76; 23.0%), miscommunication (19; 5.8%), payment systems problems (4; 1.2%), error in the execution of a clinical task (19; 5.8%), wrong treatment decision (14; 4.2%), and wrong diagnosis (13; 3.9%). Most reports were of errors that were recognized and occurred in reporters' practices. Affected patients ranged in age from 8 months to 100 years, were of both sexes, and represented all major US ethnic groups. Almost half the reports were of events which had adverse consequences. Ten errors resulted in patients being admitted to hospital and one patient died.

Conclusions: This medical error taxonomy, developed from self-reports of errors observed by family physicians during their routine clinical practice, emphasizes problems in healthcare processes and acknowledges medical errors arising from shortfalls in clinical knowledge and skills. Patient safety strategies with most effect in primary care settings need to be broader than the current focus on medication errors.

Full Text

The Full Text of this article is available as a PDF (127.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bates D. W., Cullen D. J., Laird N., Petersen L. A., Small S. D., Servi D., Laffel G., Sweitzer B. J., Shea B. F., Hallisey R. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. JAMA. 1995 Jul 5;274(1):29–34. [PubMed] [Google Scholar]
  2. Bates D. W., Leape L. L., Petrycki S. Incidence and preventability of adverse drug events in hospitalized adults. J Gen Intern Med. 1993 Jun;8(6):289–294. doi: 10.1007/BF02600138. [DOI] [PubMed] [Google Scholar]
  3. Bates D. W., Teich J. M., Lee J., Seger D., Kuperman G. J., Ma'Luf N., Boyle D., Leape L. The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc. 1999 Jul-Aug;6(4):313–321. doi: 10.1136/jamia.1999.00660313. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bhasale A. L., Miller G. C., Reid S. E., Britt H. C. Analysing potential harm in Australian general practice: an incident-monitoring study. Med J Aust. 1998 Jul 20;169(2):73–76. doi: 10.5694/j.1326-5377.1998.tb140186.x. [DOI] [PubMed] [Google Scholar]
  5. Brennan T. A., Leape L. L., Laird N. M., Hebert L., Localio A. R., Lawthers A. G., Newhouse J. P., Weiler P. C., Hiatt H. H. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med. 1991 Feb 7;324(6):370–376. doi: 10.1056/NEJM199102073240604. [DOI] [PubMed] [Google Scholar]
  6. Britt H., Miller G. C., Steven I. D., Howarth G. C., Nicholson P. A., Bhasale A. L., Norton K. J. Collecting data on potentially harmful events: a method for monitoring incidents in general practice. Fam Pract. 1997 Apr;14(2):101–106. doi: 10.1093/fampra/14.2.101. [DOI] [PubMed] [Google Scholar]
  7. Gaba D. M. Human error in anesthetic mishaps. Int Anesthesiol Clin. 1989 Fall;27(3):137–147. doi: 10.1097/00004311-198902730-00002. [DOI] [PubMed] [Google Scholar]
  8. Green L. A., Fryer G. E., Jr, Yawn B. P., Lanier D., Dovey S. M. The ecology of medical care revisited. N Engl J Med. 2001 Jun 28;344(26):2021–2025. doi: 10.1056/NEJM200106283442611. [DOI] [PubMed] [Google Scholar]
  9. Green L. A. The weekly return as a practical instrument for data collection in office based research. Fam Med. 1988 May-Jun;20(3):182–184. [PubMed] [Google Scholar]
  10. Heath I., Evans P., van Weel C. The specialist of the discipline of general practice. Semantics and politics mustn't impede the progress of general practice. BMJ. 2000 Feb 5;320(7231):326–327. doi: 10.1136/bmj.320.7231.326. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. McGuire H. H., Jr, Horsley J. S., 3rd, Salter D. R., Sobel M. Measuring and managing quality of surgery. Statistical vs incidental approaches. Arch Surg. 1992 Jun;127(6):733–738. doi: 10.1001/archsurg.1992.01420060113017. [DOI] [PubMed] [Google Scholar]
  12. Olesen F., Dickinson J., Hjortdahl P. General practice--time for a new definition. BMJ. 2000 Feb 5;320(7231):354–357. doi: 10.1136/bmj.320.7231.354. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Phillips D. P., Christenfeld N., Glynn L. M. Increase in US medication-error deaths between 1983 and 1993. Lancet. 1998 Feb 28;351(9103):643–644. doi: 10.1016/S0140-6736(98)24009-8. [DOI] [PubMed] [Google Scholar]
  14. Thomas E. J., Brennan T. A. Incidence and types of preventable adverse events in elderly patients: population based review of medical records. BMJ. 2000 Mar 18;320(7237):741–744. doi: 10.1136/bmj.320.7237.741. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Thomas E. J., Studdert D. M., Burstin H. R., Orav E. J., Zeena T., Williams E. J., Howard K. M., Weiler P. C., Brennan T. A. Incidence and types of adverse events and negligent care in Utah and Colorado. Med Care. 2000 Mar;38(3):261–271. doi: 10.1097/00005650-200003000-00003. [DOI] [PubMed] [Google Scholar]
  16. Victoroff M. S. The right intentions: errors and accountability. J Fam Pract. 1997 Jul;45(1):38–39. [PubMed] [Google Scholar]
  17. WHITE K. L., WILLIAMS T. F., GREENBERG B. G. The ecology of medical care. N Engl J Med. 1961 Nov 2;265:885–892. doi: 10.1056/NEJM196111022651805. [DOI] [PubMed] [Google Scholar]
  18. Wilson R. M., Runciman W. B., Gibberd R. W., Harrison B. T., Newby L., Hamilton J. D. The Quality in Australian Health Care Study. Med J Aust. 1995 Nov 6;163(9):458–471. doi: 10.5694/j.1326-5377.1995.tb124691.x. [DOI] [PubMed] [Google Scholar]
  19. Wilson T., Pringle M., Sheikh A. Promoting patient safety in primary care. BMJ. 2001 Sep 15;323(7313):583–584. doi: 10.1136/bmj.323.7313.583. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Quality & safety in health care are provided here courtesy of BMJ Publishing Group

RESOURCES