Risks to patient safety in remote consulting.

Abstract

Remote consulting was rolled out across general practice in 2020 in response to the COVID-19 pandemic. Although most consultations are carried out safely, in some cases remote care has contributed to adverse outcomes. To understand where the risks lie in delivering primary care remotely. Mixed method study in UK primary care settings including general practice, out of hours and 111 services. Data was collated from NHS England complaints quarterly reviews, NHS Resolution cases, 111 Wales, the HSIB report into 111 COVID services and longitudinal case ethnographic cases studies of 11 general practices. 2 reviewers coded the data and identified themes. There are staff, patient, and setting factors that contribute to risk in remote consulting. Staff factors include communication skills, over-reliance on a previous diagnosis made remotely, failure to recognise clinical findings or the urgency of a case, over/under prescribing/investigating and referring and safety netting. Patient factors include impaired communication, repeated telephone consultations, unstable chronic disease, and certain medical conditions such as chest and abdominal pain. Risk was encountered when settings had limited telephone lines, call handlers or clinicians, or where access to appointments was either restricted, hard to navigate, or where inappropriate layers of triage were applied. Processes had not always adapted for remote working, leading to risk in delayed access to acute prescriptions and delayed referrals. Attention to staff, patient, and setting factors can allow risk to be identified and addressed when providing care remotely. .