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Prevalence and consequences of patient safety incidents in general practice in the Netherlands: a retrospective medical record review study

Sander Gaal1*, Wim Verstappen1, René Wolters1, Henrike Lankveld1, Chris van Weel2 and Michel Wensing1

Author Affiliations

1 IQ healthcare, Radboud University Nijmegen Medical Centre, the Netherlands, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands

2 Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands

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Implementation Science 2011, 6:37  doi:10.1186/1748-5908-6-37

Published: 6 April 2011



Patient safety can be at stake in both hospital and general practice settings. While severe patient safety incidents have been described, quantitative studies in large samples of patients in general practice are rare. This study aimed to assess patient safety in general practice, and to show areas where potential improvements could be implemented.


We conducted a retrospective review of patient records in Dutch general practice. A random sample of 1,000 patients from 20 general practices was obtained. The number of patient safety incidents that occurred in a one-year period, their perceived underlying causes, and impact on patients' health were recorded.


We identified 211 patient safety incidents across a period of one year (95% CI: 185 until 241). A variety of types of incidents, perceived causes and consequences were found. A total of 58 patient safety incidents affected patients; seven were associated with hospital admission; none resulted in permanent disability or death.


Although this large audit of medical records in general practices identified many patient safety incidents, only a few had a major impact on patients' health. Improving patient safety in this low-risk environment poses specific challenges, given the high numbers of patients and contacts in general practice.