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Patient safety in ambulatory care from the patient's perspective: a retrospective, representative telephone survey
  1. Max Geraedts1,
  2. Svenja Krause1,
  3. Michael Schneider1,
  4. Annette Ortwein1,
  5. Johannes Leinert2,
  6. Werner de Cruppé1
  1. 1 Institute for Health Services Research and Clinical Epidemiology, Philipps-Universitat Marburg, Marburg, Germany
  2. 2 infas Institut fur angewandte Sozialwissenschaft GmbH, Bonn, Germany
  1. Correspondence to Dr Max Geraedts; geraedts{at}


Objectives Data on patient safety problems (PSPs) in ambulatory care are scarce. The aim of the study was to record the frequency, type, severity and point of origin of PSPs in ambulatory care in Germany.

Design Retrospective cross-sectional study.

Setting Computer-assisted telephone interviews with randomly recruited citizens aged ≥40 years in Germany who were asked about their experiences with PSPs in ambulatory care.

Participants 10 037 citizens ≥40 years.

Measures A new questionnaire was developed to record patient experiences with PSPs in ambulatory care. The study reported here targets patient experiences in the last 12 months. The questionnaire focuses on PSPs in seven areas of medical treatment: anamnesis/diagnostic procedures; medication; vaccination, injection, infusion; aftercare; outpatient surgery; office administration; other areas. For each PSP reported, detailed questions were asked about the specialist group concerned, and, on the most serious harm, the severity of the harm and its consequences. The target parameters are presented as proportions with 95% CIs.

Results 1422 of the respondents (14%) reported 2589 PSPs. The areas most frequently affected by PSPs were anamnesis/diagnostic procedures (61%) and medication (15%). General practitioners accounted for 44% of PSPs, orthopaedists for 15% and internists for 10%. 75% of PSPs were associated with harm, especially unnecessarily prolonged pain or deterioration of health; 35% of PSPs led to permanent harm. 804 PSPs (32%) prompted patients to see another doctor for additional treatment; 255 PSPs (10%) required inpatient treatment.

Conclusion PSPs experienced by patients are widespread in ambulatory care in Germany. The study reveals in which areas of medical treatment efforts to prevent PSPs could make the greatest contribution to improving patient safety. It also demonstrates the valuable contribution of patient reports to the analysis of PSPs.

  • patient perspective
  • ambulatory health care
  • patient safety
  • health services research

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  • MG and SK contributed equally.

  • Contributors All authors had full access to all of the data (including statistical reports and tables) in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study guarantor: MG, WdC. Study concept and design: MG, SK, JL, WdC. Analysis and interpretation of data: MG, SK, MS, AO, JL, WdC. Drafting of the manuscript: MG, SK. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: SK, MS. Study supervision: MG.

  • Funding The study received funding from the Innovation Committee of the Federal Joint Committee, Germany (grant number 01VSF16015).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval for the study was obtained through the Ethics Committee of the Philipps-Universität Marburg (AZ 179/17).

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

  • Data availability statement Data are available upon reasonable request. Deidentified data will be made available after all ongoing analyses are completed. Requesters will be required to sign a letter of agreement detailing the mechanisms by which the data will be kept secure and access restricted to their study team. The agreements will also state the recipient will not share the data with anyone outside of their research team.

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