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Most efforts to improve patient safety have focused on hospitals, although safety risks are widespread in ambulatory (outpatient) settings as well. Not enough attention has been directed at developing the evidence base needed to improve ambulatory safety, says Helen R. Burstin, M.D., M.P.H., director the Center for Primary Care Research, Agency for Healthcare Research and Quality.
A conference of health services researchers and health policy and medical group management professionals was held in late 2002. It focused on the epidemiology of patient safety in ambulatory care, strategies and methods to improve and ensure patient safety, and the effects of cultural, legislative, and regulatory environments on ambulatory patient safety.
Dr. Burstin and her colleagues summarized the conference in a recent article. Participants concluded that inadequate knowledge and understanding of the outpatient care sector severely limits the ability to understand and manage safety risks to patients. Their review of the research revealed the following high-risk areas for medical error in ambulatory care settings: failure to diagnose problems, omission of screening and followup, patient identification errors, oversedation, complex technology, and inadequately trained personnel. Infrastructure problems also create opportunities for error. For example, an episode of ambulatory care often requires communication and coordination among a number of clinicians, the patient, and family and among several different sites.
Also, more than 77 percent of all medical procedures are now performed in ambulatory settings, including many surgeries. Yet most ambulatory sites are subject to less regulation than hospitals, they have less peer interaction, and they have less well-developed policies and procedures to determine the training and experience required to perform certain procedures. Efforts now underway to improve ambulatory patient safety range from strengthening infrastructure support to making changes in the regulatory environment. The conference was supported by the Agency for Healthcare Research and Quality (HS10106) and the Centers for Medicare & Medicaid Services.
More details are in "Ambulatory patient safety: What we know and need to know," by Terry Hammons, M.D., Neill F. Piland, Ph.D., Stephen D. Small, M.D., and others, in the January 2003 Journal of Ambulatory Care Management 26(1), pp. 63-82.
Reprints (AHRQ Publication No. 03-R021) are available from the AHRQ Publications Clearinghouse.
Select to access the full patient safety report.
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