Patient-safety incidents during COVID-19 health crisis in France: An exploratory sequential multi-method study in primary care.

BACKGROUND: The COVID-19 pandemic has resulted in the rapid reorganisation of health and social care services. Patients are already at significant risk of healthcare-associated harm and the wholesale disruption to service delivery during the pandemic stood to heighten those risks. OBJECTIVES: We explored the type and nature of patient safety incidents in French primary care settings during the COVID-19 first wave to make tentative recommendations for improvement. METHODS: A national patient safety incident reporting survey was distributed to General Practitioners (GPs) in France on 28 April 2020. Reports were coded using a classification system aligned to the WHO International Classification for Patient Safety (incident types, contributing factors, incident outcomes and severity of harm). Analysis involved data coding, processing, iterative generation of data summaries using descriptive statistical analysis. Clinicaltrials.gov: NCT04346121. RESULTS: Of 132 incidents, 58 (44%) related to delayed diagnosis, assessments and referrals. Cancellations of appointments, hospitalisations or procedures was reported in 22 (17%) of these incidents. Home confinement-related incidents accounted for 13 (10%) reports and inappropriate medication stopping for five (4%). Patients delayed attending or did not consult their general practitioner or other healthcare providers due to their fear of contracting COVID-19 infection at an in-person visit in 26 (10%) incidents or fear of burdening their GPs in eight (3%) incidents. CONCLUSION: Constraints from the first wave of the COVID-19 pandemic have contributed to patient safety incidents during non-COVID-19 care. Lessons from these incidents pinpoint where primary care services in France can focus resources to design safer systems for patients

ÉVénements InDésirables EN équipes coordonnées de Soins PRIMaires : protocole de l’étude EVIDENS-PRIM

International audienceContexte : Dans la littérature internationale, les soins primaires sont perçus comme un environnement à faible risque d’Évènements Indésirables Associés aux Soins (EIAS). Pourtant, 1 à 2 % des consultations de médecine générale entraîneraient des EIAS, graves dans 4 à 7 % des cas. En France, l’avenant 1 de l’Accord Conventionnel Interprofessionnel a missionné en 2022 les Maisons de Santé Pluriprofessionnelles (MSP), d’implémenter leur propre démarche de Gestion des Risques (GDR) pour prévenir les EIAS. Aussi, un système d’apprentissage de la GDR permettrait (i) aux MSP d’implémenter la démarche, et (ii) aux politiques de santé de disposer d’une première typologie des EIAS survenant en exercice coordonné.Objectif principal : Décrire les EIAS survenant en MSP selon les 4 cadres de codage de la classification internationale Primary Care Patient Safety (PISA) : (i) types d’EIAS, ii) facteurs contributifs, iii) résultats des EIAS, iv) gravité du préjudice.Méthodes et analyses :Design. Etude séquentielle d’analyse des EIAS, multicentrique et prospective (36 mois).Système d’apprentissage. A destination des professionnels de ville. Développé à partir de guides internationaux et avec des professionnels de terrain. Associant (i) un programme d’accompagnement à la GDR et (ii) la mise à disposition d’une plateforme web support aux déclarations et analyses des EIAS. Accompagnement dispensé par une Structure Régionale d’Appui en qualité et sécurité des soins.Recueil et traitement des données. 3 étapes : (i) formation des codeurs, (ii) extraction des données des EIAS via la plateforme web, (iii) codage des EIAS. Chaque EIAS déclaré par les professionnels lors de l’implémentation de la démarche GDR, sera codé systématiquement et chronologiquement selon les neuf règles du modèle récursif d'analyse des EIAS de l'Australian Patient Safety Foundation.Nombre de sujets nécessaires. Inclusion de 15 MSP en Pays de la Loire avec une participation attendue de 7 professionnels/MSP. Au moins 1890 EIAS devraient être déclarés.Analyses statistiques. Analyses (i) descriptives des données codées (ii) exploratoires identifiant les domaines prioritaires pour des actions d’amélioration.Discussion : EVIDENS-Prim a pour ambition d’autonomiser les professionnels dans l’implémentation de la démarche GDR et d’améliorer la sécurité des patients qui y sont suivis. Elle proposera des mesures pour prévenir la survenue des EIAS en soins primaires

Seasonal variation of mercury contamination in Arctic seabirds: A pan-Arctic assessment

Mercury (Hg) is a natural trace element found in high concentrations in top predators, including Arctic seabirds. Most current knowledge about Hg concentrations in Arctic seabirds relates to exposure during the summer breeding period when researchers can easily access seabirds at colonies. However, the few studies focused on winter have shown higher Hg concentrations during the non-breeding period than breeding period in several tissues. Hence, improving knowledge about Hg exposure during the non-breeding period is crucial to understanding the threats and risks encountered by these species year-round. We used feathers of nine migratory alcid species occurring at high latitudes to study bird Hg exposure during both the breeding and non-breeding periods. Overall, Hg concentrations during the non-breeding period were ~3 times higher than during the breeding period. In addition, spatial differences were apparent within and between the Atlantic and Pacific regions. While Hg concentrations during the non-breeding period were ~9 times and ~3 times higher than during the breeding period for the West and East Atlantic respectively, Hg concentrations in the Pacific during the non-breeding period were only ~1.7 times higher than during the breeding period. In addition, individual Hg concentrations during the non-breeding period for most of the seabird colonies were above 5 μg g−1 dry weight (dw), which is considered to be the threshold atwhich deleterious effects are observed, suggesting that some breeding populations might be vulnerable to non-breeding Hg exposure. Since wintering area locations, and migration routes may influence seasonal Hg concentrations, it is crucial to improve our knowledge about spatial ecotoxicology to fully understand the risks associated with Hg contamination in Arctic seabirds. Polar Top predators Metal Seasonal variation FeathersacceptedVersio

Seasonal variation of mercury contamination in Arctic seabirds: a pan- arctic assessment

International audienceMercury (Hg) is a natural trace element found in high concentrations in top predators, including Arctic seabirds. Most current knowledge about Hg concentrations in Arctic seabirds relates to exposure during the summer breeding period when researchers can easily access seabirds at colonies. However, the few studies focused on winter have shown higher Hg concentrations during the non-breeding period than breeding period in several tissues. Hence, improving knowledge about Hg exposure during the non-breeding period is crucial to understanding the threats and risks encountered by these species year-round. We used feathers of nine migratory alcid species occurring at high latitudes to study bird Hg exposure during both the breeding and non-breeding periods. Overall, Hg concentrations during the non-breeding period were ~3 times higher than during the breeding period. In addition, spatial differences were apparent within and between the Atlantic and Pacific regions. While Hg concentrations during the non-breeding period were ~9 times and ~3 times higher than during the breeding period for the West and East Atlantic respectively, Hg concentrations in the Pacific during the non-breeding period were only ~1.7 times higher than during the breeding period. In addition, individual Hg concentrations during the non-breeding period for most of the seabird colonies were above 5.00 µg g-1 dry weight (dw), which is considered to be the threshold at which deleterious effects are observed, suggesting that some breeding populations might be vulnerable to non-breeding Hg exposure. Since wintering area locations, and migration routes may influence seasonal Hg concentrations, it is crucial to improve our knowledge about spatial ecotoxicology to fully understand the risks associated with Hg contamination in Arctic seabirds