To err is human, but what about physiotherapy errors in acute care hospitals? A mixed-methods study.

This cross-sectional, mixed-methods study aimed to capture and categorize errors from certified physiotherapists working in acute care hospitals in the Canton of Bern, Switzerland.

The research questions were investigated with an anonymous, web-based, a-priori piloted survey using qualitative and quantitative methods. Physiotherapists (hospital-based, ≥18 years old with written electronical consent) were recruited via partner institutions, personal contacts, a newsletter from the local professional association, and snowballing. Error content was thematically analysed and categorized by their severity according to the Swiss Patient Safety Foundation by two independent researchers. Thematic analysis and error categorization were then finalised through a consensus discussion with a third expert. Quantitative data was analysed descriptively and graphically. 

Sixty-two physiotherapists reported a total of 79 errors. Physiotherapists experienced errors across all ranges of professional experiences (1-5 years (34 [48%]), 5-10 years (20 [28%]) and >10 years (17 [24%])) and specialities (musculoskeletal (32 [44%]), medical (15 [21%]), neurological (9 [13%]), other (16 [22%])). Thematic analysis identified 16 themes, with the most common errors reported as ‘incorrect procedure’ (24 [30%]), ‘fall’ (23 [29%]) or ‘incorrect load’ (13 [17%]). Anchor examples include statements of “The bladder catheter was forgotten […]”, “Patient glides to the floor during the transfer from bed to chair […] a chain of unfavourable circumstances” and “[…] the screw in the hip had probably dislocated”. The majority of errors caused no harm (58 [73%]) (Categories A-D), though some of these (30 [38%]) (Category D) required monitoring or an intervention. Nonetheless, 21 [27%] of the reported errors were associated with temporary or permanent harm, including death (Categories E-I). 

In this mixed-methods study, physiotherapists in acute care hospitals reported a wide range of errors, whereby one in four was related to temporary or permanent harm. Previous research reported similar error themes such as incorrect procedures, mismanagement, communication errors or falls. This research revealed new themes including shortened treatments, incorrect wheelchair handling, lack of knowledge, overlooked contraindications, poor hygiene measures, inadequate patient management, patient mix-ups, underdosing, and omission errors. The findings indicate that physiotherapy treatments carry risks and can lead to harm, highlighting the need to openly discuss, analyse, and address these errors through monitoring and by establishing a safety culture.

To err is human and the physiotherapy profession is no exception. Identifying the nature of errors is an important first step for future research to prevent harm in physiotherapy and to ultimately establish a transparent, interprofessionally shared safety culture in acute care hospitals. Physiotherapists are encouraged to share errors within their team and to improve patient safety by learning from each other.