Open Access Open Badges Research article

Tools for measuring patient safety in primary care settings using the RAND/UCLA appropriateness method

Brian G Bell12*, Rachel Spencer12, Anthony J Avery12 and Stephen M Campbell23

Author Affiliations

1 Division of Primary Care, School of Community Health Sciences, University of Nottingham University Park, Medical School, Queen’s Medical Centre, Nottingham NG7 2UH, England, UK

2 NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, 7th Floor, Williamson Building, Manchester M13 9PL, England, UK

3 Centre for Primary Care, University of Manchester, 7th Floor, Williamson Building, Manchester M13 9PL, EnglandUK

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BMC Family Practice 2014, 15:110  doi:10.1186/1471-2296-15-110

Published: 5 June 2014



The majority of patient contacts occur in general practice but general practice patient safety has been poorly described and under-researched to date compared to hospital settings. Our objective was to produce a set of patient safety tools and indicators that can be used in general practices in any healthcare setting and develop a ‘toolkit’ of feasible patient safety measures for general practices in England.


A RAND/UCLA Appropriateness Method exercise was conducted with a panel of international experts in general practice patient safety. Statements were developed from an extensive systematic literature review of patient safety in general practice. We used standard RAND/UCLA Appropriateness Method rating methods to identify necessary items for assessing patient safety in general practice, framed in terms of the Structure-Process-Outcome taxonomy. Items were included in the toolkit if they received an overall panel median score of ≥7 with agreement (no more than two panel members rating the statement outside a 3-point distribution around the median).


Of 205 identified statements, the panel rated 101 as necessary for assessing the safety of general practices. Of these 101 statements, 73 covered structures or organisational issues, 22 addressed processes and 6 focused on outcomes.


We developed and tested tools that can lead to interventions to improve safety outcomes in general practice. This paper reports the first attempt to systematically develop a patient safety toolkit for general practice, which has the potential to improve safety, cost effectiveness and patient experience, in any healthcare system.

Primary health care; Consensus; Patient safety; Quality indicators