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Walker K1, Trifogli S1, Amey H1, Davies L1, Hibbert P2, Pocovi N1, Watts I3, Jones T1, Carson-Stevens A2,4, Dean C1
1Faculty of Medicine and Health Sciences, Macquarie University, Health Professions, Sydney, Australia, 2Australian Institute of Health and Innovation, Macquarie University, Centre for Healthcare Resilience and Implementation Science, Sydney, Australia, 3Australian Physiotherapy Association, Policy and Government Relations, Melbourne, Australia, 4Cardiff University, Division of Population Health, Cardiff, United Kingdom
Background: To date, analysis of patient safety incidents as a means to drive improvements in safety and quality in healthcare have been conducted within the medical and nursing professions and predominantly within hospital settings. Little research has been conducted concerning the physiotherapy profession.
Purpose: To examine the nature of patient safety claims that occur within the practice of physiotherapy in Australia.
Methods: Using a mixed methods approach, all notifications made to the Australian Physiotherapy Association (APA) professional indemnity insurer between 2013-2017 were coded based on the WHO International Classification for Patient Safety (WHO-ICPS) framework independently by two trained researchers. Codes were assigned to incident types, contributing factors, severity and type of outcome to patients. Any discrepancy between the primary researchers was then reviewed by a third and fourth researcher and resolved. The resulting coded data was then analysed using descriptive statistics.
Results: A total of 371 of 401 notifications were included for analysis. The four most common incident types were: treatment (n= 183, 49%); behaviour (n= 86, 23%); patient accident (n= 66, 18%); and falls (n= 55, 15%). Importantly, in the 70% (n= 261) of notifications with outcomes reported, 89% (n= 231) were classified as resulting in patient harm, either involving injury or a change in physiological parameters. 123 notifications (33%) resulted in costs to the professional indemnity insurer and only 13 (4%) rose to settlements. Treatment (n= 60, 49%) and behaviour (n= 34, 27%) were the main incident types that incurred costs to the professional indemnity insurer. The highest cost incurred was $1,230,533.82 which arose from a treatment incident. Treatment modalities and outcomes were also investigated, however conclusions in these classifications were limited by the level of detail within the reports. Overall, more notifications were made against male physiotherapists, particularly those that resulted in costs to the insurer (n= 84, 68%), despite there being more female members within the Australian Physiotherapy Association.
Conclusion(s): This is the first study to code patient safety claims within the physiotherapy profession in Australia. By understanding the nature of patient harm, we have the potential to reduce it. We have identified that adverse events occur commonly in treatment and in most cases result in harm to the patient. Adverse events also result in costs to the insurer. Costs which are ultimately passed onto the insurered population of physiotherapists. Comprehensive notification of claims will enable the physiotherapy profession to develop targeted strategies to enhance patient safety during physiotherapy.
Implications: Patient safety claims are commonly limited by under-reporting, selective-reporting and incomplete-reporting. As a profession and as individual practitioners we can learn from our claims and other patient safety sources such as incident reporting systems to facilitate improvements in safety. We encourage more physiotherapists to notify their insurer of patient safety incidents, including near misses to assist physiotherapists in developing strategies to avert patient harm within their practice.
Keywords: Patient Safety, Professional Indemnity Insurance, Safety and Quality
Funding acknowledgements: The Australian Physiotherapy Association assisted in collating the data and providing a de-identified dataset for analysis.
Purpose: To examine the nature of patient safety claims that occur within the practice of physiotherapy in Australia.
Methods: Using a mixed methods approach, all notifications made to the Australian Physiotherapy Association (APA) professional indemnity insurer between 2013-2017 were coded based on the WHO International Classification for Patient Safety (WHO-ICPS) framework independently by two trained researchers. Codes were assigned to incident types, contributing factors, severity and type of outcome to patients. Any discrepancy between the primary researchers was then reviewed by a third and fourth researcher and resolved. The resulting coded data was then analysed using descriptive statistics.
Results: A total of 371 of 401 notifications were included for analysis. The four most common incident types were: treatment (n= 183, 49%); behaviour (n= 86, 23%); patient accident (n= 66, 18%); and falls (n= 55, 15%). Importantly, in the 70% (n= 261) of notifications with outcomes reported, 89% (n= 231) were classified as resulting in patient harm, either involving injury or a change in physiological parameters. 123 notifications (33%) resulted in costs to the professional indemnity insurer and only 13 (4%) rose to settlements. Treatment (n= 60, 49%) and behaviour (n= 34, 27%) were the main incident types that incurred costs to the professional indemnity insurer. The highest cost incurred was $1,230,533.82 which arose from a treatment incident. Treatment modalities and outcomes were also investigated, however conclusions in these classifications were limited by the level of detail within the reports. Overall, more notifications were made against male physiotherapists, particularly those that resulted in costs to the insurer (n= 84, 68%), despite there being more female members within the Australian Physiotherapy Association.
Conclusion(s): This is the first study to code patient safety claims within the physiotherapy profession in Australia. By understanding the nature of patient harm, we have the potential to reduce it. We have identified that adverse events occur commonly in treatment and in most cases result in harm to the patient. Adverse events also result in costs to the insurer. Costs which are ultimately passed onto the insurered population of physiotherapists. Comprehensive notification of claims will enable the physiotherapy profession to develop targeted strategies to enhance patient safety during physiotherapy.
Implications: Patient safety claims are commonly limited by under-reporting, selective-reporting and incomplete-reporting. As a profession and as individual practitioners we can learn from our claims and other patient safety sources such as incident reporting systems to facilitate improvements in safety. We encourage more physiotherapists to notify their insurer of patient safety incidents, including near misses to assist physiotherapists in developing strategies to avert patient harm within their practice.
Keywords: Patient Safety, Professional Indemnity Insurance, Safety and Quality
Funding acknowledgements: The Australian Physiotherapy Association assisted in collating the data and providing a de-identified dataset for analysis.
Topic: Professional issues; Professional issues; Professionalism & ethics
Ethics approval required: Yes
Institution: Macquarie University
Ethics committee: Faculty of Medicine and Health Sciences Low-risk Ethics Sub-committee
Ethics number: 5201700795
All authors, affiliations and abstracts have been published as submitted.
