Patient-safety incidents during COVID-19 health crisis in France: an exploratory sequential multi-method study in primary care

Background. The COVID-19 pandemic has resulted in rapid reorganization of health and social care services. Patients are already at significant risk of healthcare-associated harm and the wholesale disruption to service delivery during the pandemic stood to heighten those risks. Objective. We explored the type and nature of patient safety incidents in French primary care settings during the COVID-19 first wave to make tentative recommendations for improvement. Methods. A national patient safety incident reporting survey was distributed to General Practitioners (GPs) in France on April 28, 2020. Reports were coded using a classification system aligned to the WHO International Classification for Patient Safety (incident types, contributing factors, incident outcomes and severity of harm). Analysis involved data coding, processing, iterative generation of data summaries using descriptive statistical and thematic analysis. Clinicaltrials.gov: NCT04346121. Results. Of 132 incidents, 58 (44%) related to delayed diagnosis, assessments and referrals. Cancellations of appointments, hospitalizations or procedures was reported in 22 (17%) of these incidents. Home confinement-related incidents accounted for 15 (10%) reports, and inappropriate stopping of medications for five (4%). Patients delayed attending or did not consult their general practitioner or other healthcare providers due to their fear of contracting COVID-19 infection at an in-person visit in 26 (10%) incidents, or fear of burdening their GPs in eight (3%) incidents. Conclusion. Constraints arising from the first wave of the COVID-19 pandemic have contributed to patient safety incidents during non-COVID-19 care. Lessons from these incidents pinpoint where primary care services in France can focus resources to design safer systems for patients.