{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,25]],"date-time":"2025-10-25T12:43:54Z","timestamp":1761396234032,"version":"3.44.0"},"reference-count":40,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2022,3,8]],"date-time":"2022-03-08T00:00:00Z","timestamp":1646697600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100014013","name":"UK Research and Innovation","doi-asserted-by":"publisher","award":["COVID-19 Emergency Fund via ESRC and NIHR ES\/V0100"],"award-info":[{"award-number":["COVID-19 Emergency Fund via ESRC and NIHR ES\/V0100"]}],"id":[{"id":"10.13039\/100014013","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["Senior Investigator Award WT104830MA"],"award-info":[{"award-number":["Senior Investigator Award WT104830MA"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Qual Saf"],"accepted":{"date-parts":[[2022,2,5]]},"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The introduction of remote triage and assessment early in the pandemic raised questions about patient safety. We sought to capture patients and clinicians\u2019 experiences of the management of suspected acute COVID-19 and generate wider lessons to inform safer care.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting and sample<\/jats:title>\n                  <jats:p>UK primary healthcare. A subset of relevant data was drawn from five linked in-pandemic qualitative studies. The data set, on a total of 87 participants recruited via social media, patient groups and snowballing, comprised free text excerpts from narrative interviews (10 survivors of acute COVID-19), online focus groups (20 patients and 30 clinicians), contributions to a Delphi panel (12 clinicians) and fieldnotes from an online workshop (15 patients, clinicians and stakeholders).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Data were uploaded onto NVivo. Coding was initially deductive and informed by WHO and Institute of Medicine frameworks of quality and safety. Further inductive analysis refined our theorisation using a wider range of theories\u2014including those of risk, resilience, crisis management and social justice.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In the early weeks of the pandemic, patient safety was compromised by the driving logic of \u2018stay home\u2019 and \u2018protect the NHS\u2019, in which both patients and clinicians were encouraged to act in a way that helped reduce pressure on an overloaded system facing a novel pathogen with insufficient staff, tools, processes and systems. Furthermore, patients and clinicians observed a shift to a more transactional approach characterised by overuse of algorithms and decision support tools, limited empathy and lack of holistic assessment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Lessons from the pandemic suggest three key strategies are needed to prevent avoidable deaths and inequalities in the next crisis: (1) strengthen system resilience (including improved resourcing and staffing; support of new tools and processes; and recognising primary care\u2019s role as the \u2018risk sink\u2019 of the healthcare system); (2) develop evidence-based triage and scoring systems; and (3) address social vulnerability.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjqs-2021-013305","type":"journal-article","created":{"date-parts":[[2022,3,8]],"date-time":"2022-03-08T13:25:12Z","timestamp":1646745912000},"page":"732-741","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["Safety implications of remote assessments for suspected COVID-19: qualitative study in UK primary care"],"prefix":"10.1136","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7758-8493","authenticated-orcid":false,"given":"Sietse","family":"Wieringa","sequence":"first","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7107-7211","authenticated-orcid":false,"given":"Ana Luisa","family":"Neves","sequence":"additional","affiliation":[{"name":"Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK"}]},{"given":"Alexander","family":"Rushforth","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"},{"name":"CWTS, University of Leiden, Leiden, The Netherlands"}]},{"given":"Emma","family":"Ladds","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}]},{"given":"Laiba","family":"Husain","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}]},{"given":"Teresa","family":"Finlay","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8935-6702","authenticated-orcid":false,"given":"Catherine","family":"Pope","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"},{"name":"NIHR CLAHRC Wessex, University of Southampton, Southampton, UK"}]},{"given":"Trisha","family":"Greenhalgh","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"}]}],"member":"239","published-online":{"date-parts":[[2022,3,8]]},"reference":[{"key":"2025090413164389000_32.12.732.1","unstructured":"Institute of Medicine (US) Committee on Quality of Health Care in America . 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