The evolution of patient-reported safety concerns during the COVID-19 pandemic within a series of study questionnaires: a multi-method analysis

Background The COVID-19 pandemic had a profound impact on healthcare systems globally, with the potential to aggravate levels of healthcare-associated harm. Due to radical changes within service provision, this period was considered likely to influence patient-reported safety concerns. We aimed to characterise the nature of these safety concerns at different time periods after the first UK lockdown. Methods A patient-reported safety concerns module was included within the UK COVID-19 Public Experience (COPE) study surveys at three time points: March/April 2021, September/November 2021, and March/April 2022. Participants were asked whether they had experienced any safety concerns whilst using healthcare services during the previous six months, the nature of the concern(s), and to provide a free-text response to describe it. Free-text data were reviewed to identify reports that met the National Health Service (NHS) definition of a patient safety incident. Descriptive analysis was undertaken to identify incident type, contributory factors, and patient outcomes, followed by thematic analysis of the most frequently reported incidents. Results Data from 11,604 completed questionnaires were screened over the three time points, and 1,363 (10.0%) participants reported a safety concern, and 722 (53%) concerns met the definition of a patient safety incident: 262/499 (53%) at 12 months; 215/456 (47.1%) at 18 months; and 245/408 (60.1%) at 24 months. The most frequently reported safety incidents involved access to healthcare professionals (12 months/18 months), and errors managing healthcare appointments (24 months). Prominence of themes fluctuated over time, as the context and policies that influenced the safety reports shifted. For example, geographical limitations on healthcare were evident at 12 months, mitigation from healthcare-associated harm by family members at 18 months, and concerns surrounding healthcare professional and other patient’s behaviour at 24 months. Conclusion Healthcare organisations are undoubtedly still undergoing a protracted period of recovery. However, to protect health services from any further threats to functioning, organisations must review patient safety data systems and examine staff perspectives on the issues identified, notably in relation to infection control policies, social distancing, and patient access to health services. Learning from patient-reported experiences and considering how safety incidents are defined would support improvements in patient safety.