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Health and social care-associated harm amongst vulnerable children in primary care: mixed methods analysis of national safety reports
  1. Adhnan Omar1,
  2. Philippa Rees1,2,
  3. Alison Cooper1,
  4. Huw Evans1,
  5. Huw Williams1,
  6. Peter Hibbert3,4,
  7. Meredith Makeham5,
  8. Gareth Parry6,7,
  9. Liam Donaldson8,
  10. Adrian Edwards1,
  11. Andrew Carson-Stevens1,3
  1. 1 Division of Population Medicine, Cardiff University, Cardiff, UK
  2. 2 Population Policy and Practice, University College London Institute of Child Health, London, UK
  3. 3 Australian Institute of Health Innovation, Macquarie University Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
  4. 4 Division of Health Sciences, School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
  5. 5 Department on Clinical Medicine, Macquarie University Faculty of Medicine and Health Sciences, Sydney, New South Wales, Australia
  6. 6 Institute for Healthcare Improvement, Cambridge, Massachusetts, USA
  7. 7 Harvard Medical School, Harvard University, Cambridge, Massachusetts, USA
  8. 8 Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to Dr Andrew Carson-Stevens, Division of Population Medicine, Cardiff University, Cardiff CF14 4YS, UK; carson-stevensap{at}


Purpose Patient safety failures are recognised as a global threat to public health, yet remain a leading cause of death internationally. Vulnerable children are inversely more in need of high-quality primary health and social-care but little is known about the quality of care received. Using national patient safety data, this study aimed to characterise primary care-related safety incidents among vulnerable children.

Methods This was a cross-sectional mixed methods study of a national database of patient safety incident reports occurring in primary care settings. Free-text incident reports were coded to describe incident types, contributory factors, harm severity and incident outcomes. Subsequent thematic analyses of a purposive sample of reports was undertaken to understand factors underpinning problem areas.

Results Of 1183 reports identified, 572 (48%) described harm to vulnerable children. Sociodemographic analysis showed that included children had child protection-related (517, 44%); social (353, 30%); psychological (189, 16%) or physical (124, 11%) vulnerabilities. Priority safety issues included: poor recognition of needs and subsequent provision of adequate care; insufficient provider access to accurate information about vulnerable children, and delayed referrals between providers.

Conclusion This is the first national study using incident report data to explore unsafe care amongst vulnerable children. Several system failures affecting vulnerable children are highlighted, many of which pose internationally recognised challenges to providers aiming to deliver safe care to this at-risk cohort. We encourage healthcare organisations globally to build on our findings and explore the safety and reliability of their healthcare systems, in order to sustainably mitigate harm to vulnerable children.

  • paediatric practice
  • qualitative research
  • health services research
  • epidemiology
  • adolescent health

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  • Contributors AO carried out the primary coding, undertook the thematic analysis, drafted the initial manuscript and reviewed and revised the manuscript. AC completed the double coding, discussed coding queries at weekly team meetings and reviewed and revised the manuscript. HW and HE discussed coding queries at weekly team meetings, and reviewed and revised the manuscript. PR, PH, MM, GP, LD and AE critically reviewed and revised the manuscript. AC-S conceptualised and designed the study, coordinated and supervised the project, acted as arbitrator in the double coding process and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

  • Funding All co-authors contributed to a project funded by the National Institute for Health and Services and Delivery Research Programme (project number 12/64/118).

  • Disclaimer The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HS&DR Programme, NIHR, NHS or the Department of Health. The funders have no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Aneurin Bevan University Health board research risk review committee waived ethical approval (ABHB R and D Ref number: SA/410/13).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The data that support the findings of this study are available on permission of NHS Improvement. Restrictions apply to the availability of these data, which were used under a Data Sharing Agreement with Cardiff University for this study.

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