This is the published version:   Giles,Sally,Panagioti,Maria,Hernan,Andrea,Cheraghi‐Sohi,SudehandLawton,Rebecca2015,Contributoryfactorstopatientsafetyincidentsinprimarycare:protocolforasystematicreview,SystematicReviews,vol.4,no.63,pp.1‐7.

Available from Deakin Research Online:  http://hdl.handle.net/10536/DRO/DU:30073286ReproducedwiththekindpermissionofthecopyrightownerCopyright:2015,BioMedCentral

et al

et al

1. To identify factors contributing to patient safetyincidents within a primary care setting.

2. To build a draft contributory factors framework forprimary care. Further qualitative work will follow totest and further develop the framework.

System/contributory Fac-tors, Patient Safety Primary Care

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A. For any study type (including review articles andopinion pieces):1) Is it an empirical research?

YES, NO, UNSUREIs it worth continuing?

2) Does it make reference to contributory factors topatient safety incidents?

YES, NO, UNSUREIs it worth continuing?

3) The research has been conducted in primarycare?

YES, NO, UNSUREIs it worth continuing?

� Types of studies: We will include empirical studieswhich provide data on factors that contribute topatient safety incidents in primary care. Studydesigns will not be restricted and will include bothquantitative designs (that is, randomised controlledtrials, quasi-experimental studies, cohort studies,cross-sectional studies) and qualitative studiesincluding case studies. We will also include greyliterature reports.

� Types of participants: patients in primary care. Wewill not exclude participants on the basis of age ordiagnosis.

� Phenomena of interest: contributory factors of activefailures or threats to patient safety. On the basis ofthe findings, an existing systematic review whichexamined contributory factors to patient safetyincidents in secondary care settings, we anticipatethat such contributory factors may include

healthcare system/organisational factors (forexample, communication failures between differentprofessionals or patient-professional communicationfailures, staff workload, training/education, supervision/leadership, availability/use of equipment and supplies;policy issues; characteristics of the physicalenvironment), health professional factors (inexperience,stress, personality attitudes) and patient factors(for example, language problems, personalitycharacteristics, multimorbidity).

� Setting/context: We will focus on identifying studiesconducted in primary care. We will also includestudies conducted in the interface of primary andsecondary care. We defined primary care as ‘themedical care involving first contact and on-goingcare to patients, regardless of the patient’s age,gender or presenting problem’[19]. We will notrestrict our search in specific geographical areas ordate of publication.

� Articles not published in English (for pragmaticreasons such as translation difficulties)

� Non-empirical studies (primarily because we aim tobuild our conceptual framework based on empiricalevidence rather than theoretical hypotheses andviews that have not been empirically tested.Additionally, we do not expect to find any relevantsystematic reviews of empirical studies given the lackof systematic evidence in this research area)

� Studies that report only patient safety incidentswithout providing information on factors that mayaccount for these incidents

� Studies relating to home care (considered to becontextually different from general primary caresettings).

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1) A response rate of 70% or greater at baseline2) Adequate control for confounding factors in analysis3) A follow-up rate of greater than 70% (in prospective

studies).

� Study characteristics - year, objective, researchmethod, setting, country.

� Participant characteristics - number, age, gender,diagnoses.

� Patient safety incident type and characteristics� Practice characteristics

� Main outcomesI. Contributory factors to patient safety in

primary care� Results of the study quality appraisal.

Review 25% for

homogeneity

Rejected by 2

reviewers

Accepted by 2

reviewers

Accepted by 1

of 2 reviewers

EXCLUDE

Medline CINAH EMBASE

Create database

Identify duplicates

Original articles

SCREENING

(titles/abstracts)

Rejected by 2

reviewers

Accepted by at

least 1 reviewer

Review 10% for

homogeneity

SCREENING

(full text)

EXCLUDE

INCLUDEDiscussion until

consensus achieved

EXCLUDE

PsycInfo

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