WP6: Patient Safety & Health Care Improvement

0.25 million UK patients experience harm in primary and emergency care settings annually, from >1million unpredictable encounters per day. Despite this, there is a paucity of research and development on the quality and safety of primary and emergency care delivery.

To advance this agenda, research priorities in these settings, include: establishing the epidemiology of care quality in terms of the frequency, burden and preventability of harm, as well as the development, testing and implementation of interventions in priority areas.

In addition, the development / refinement of methods is needed to learn from, in isolation and combination, routine health care data (e.g. safety incident reports), existing research and improvement activity, expert consensus, and empirical data collected from the field.

To achieve this, we are developing and building on existing work partnerships with the Institute for Healthcare Improvement and Harvard Medical School in Boston, USA; the Australian Institute for Healthcare Innovation at Macquarie University in Sydney; the Department of Family Practice at the University of British Columbia in Vancouver; and the University of Edinburgh, University of Nottingham, and Imperial College, London in the UK.

Core activities

  • Epidemiology: Determine the frequency, burden and preventability of iatrogenic harm and poor quality care in primary (2015-17) and emergency care (2016-18). This will include exploring options for data linkage.
  • Secondary analysis of routine data: Characterise patient safety incident report data from primary care. Identify ways to improve reporting and learning from patient safety incident reports. Derive organisational learning to inform improvement initiative.
  • Intervention development: Identify, prioritise and test interventions to prevent poor quality outcomes in primary and emergency care.
  • International impact: Contribute to the development of the World Health Organization (WHO) Safer Primary Care Road Map.


Dr Andrew Carson-Stevens, Cardiff University

Current projects


Improving the safety of vaccine delivery. Evans HP, Williams H, Cooper A, Carson-Stevens A. Hum Vaccin Immunother. 2016 May 3;12(5):1280-1. doi: 10.1080/21645515.2015.1137404.

Patient safety research in primary care: where are we now? Cooper A and Chuter A. Br J Gen Pract 2015 Dec; 65 (641): 622-623.

A cross-sectional mixed methods study protocol to generate learning from patient safety incidents reported from general practice. Carson-Stevens A, Hibbert P, Avery A, Butlin A, Carter B, Cooper A, Evans H, Gibson R, Luff D, Makeham M, McEnhill P, Panesar S, Parry G, Rees P, Peebles E, Sheikh A, Ward H, Williams H, Wood F, Donaldson L, Edwards A. BMJ Open. 12/2015; 5(12).

Harms from Discharge to Primary Care - Mixed Methods Analysis of Patient Safety Incident Reports. Williams H, Edwards A, Hibbert P, Rees P, Panesar S, Carter B, Makeham M, Jones A, Avery A, Sheikh A, Donaldson L, Carson-Stevens A. British Journal of General Practice 11/2015; 65 (641):e829-837.

Reducing the burden of iatrogenic harm in children. Carson-Stevens A, Edwards A, Panesar S, Parry G, Rees P, Sheikh A, Donaldson L Lancet, Volume 385, 9978 April 2015 pp.1593-1594

Identifying priorities for improved child healthcare: a mixed methods analysis of safety incident reports. Philippa Rees, Adrian Edwards, Colin Powell, Huw Williams, Peter Hibbert, Meredith Makeham, Donna Luff, Gareth Parry, Aziz Sheikh, Liam Donaldson, Andrew Carson-Stevens. BMJ Quality & Safety 11/2015; 24(11):730-731. DOI:10.1136/bmjqs-2015-IHIabstracts

Vulnerable children and their care quality issues: a descriptive analysis of a national database. Omar A, Rees P, Prosser Evans H, Williams H, Cooper A, Banerjee S, Hibbert P, Makeham M, Parry G, Donaldson L, Edwards A and Carson-Stevens A. BMJ Quality & Safety 11/2015; 24(11):732-733. DOI: 10.1136/bmjqs-2015-IHIabstracts

How Safe is Primary Care? A Systematic Review. Panesar S, De Silva D, Carson-Stevens A, Cresswell K, Salvilla SA, Slight SP, Javad S, Netuveli G, Larizgoitia I, Donaldson LJ, Bates DW, Sheikh A. BMJ Qual Saf. doi:10.1136/bmjqs-2015-004178

Opportunities for incident reporting. Huw Williams, Alison Cooper, Andrew Carson-Stevens. BMJ Quality & Safety 11/2015; DOI:10.1136/bmjqs-2015-004962