What goes wrong in out-of-hours primary care in Denmark? A compensation claim analysis using the healthcare complaints analysis tool.

Abstract

Out-of-hours primary care (OOH-PC) services are complex clinical environments where suboptimal care may occur. Clinicians often work under time pressure and with limited access to patients' medical history, increasing the risk of errors such as underestimation of urgency or care needs, potentially resulting in diagnostic delays and inappropriate care pathways. Patient compensation claims represent a valuable source for identifying quality and safety issues that may otherwise remain undetected. To identify and categorise harm and failures in Danish OOH-PC by analysing patient compensation claims using the Healthcare Complaints Analysis Tool (HCAT). We conducted a retrospective cohort study of patient compensation claims filed with the Danish Patient Compensation Association following OOH-PC contacts. Compensation claims were settled between 2019 and 2023. All claims were analysed using the HCAT framework to classify problem domains, categories, severity and patient-reported harm. A subanalysis of 595 claims with OOH-PC as sole actor was performed to identify harm hot spots (frequent subcategories with high level of harm). A total of 1162 compensation claims related to OOH-PC were filed; 159 (13.7%) received compensation. Of the 1162 claims, 953 (82.0%) were eligible for analysis with the HCAT. Most problems occurred in the clinical domain (n=753, 67.5%), and the most common category was safety (n=526, 47.1%). Regarding problem severity, 92.4% were classified as medium (n=714) or high (n=317). In terms of patient-reported harm, 30.2% (n=351) of claims described catastrophic harm. Among the 595 claims where OOH-PC was the sole actor, 51% (n=151) of the identified harm hot spots concerned the safety category within the clinical domain. This study reveals key harm patterns in Danish OOH-PC, with problems concerning the safety problem category as major contributors. Compensation claims revealed overt safety issues, highlighting the need for structured monitoring tools and complementary data sources to enhance patient safety in this high-risk setting.