Spotlight shifts to outpatient safety

It may be a bigger challenge to prevent errors in the ambulatory setting than in hospitals.

By Kevin B. O'Reilly, AMNews staff. June 12, 2006.

San Francisco -- Missing lab results. Illegible prescriptions. Patients who don't understand doctors' instructions. Referrals that are not pursued. Medical errors in the outpatient setting might not receive as much attention as wrong-site surgeries or hospital-acquired infections, but they are just as real and can cause more harm in the aggregate, according to patient-safety experts at the eighth annual National Patient Safety Foundation's Patient Safety Congress last month.

"Errors are pervasive" in ambulatory care, said Terry Hammons, MD, senior vice president of research and information for the Medical Group Management Assn. "Ambulatory care is logistically complex. There are lots of missed connections."

Robert M. Wachter, MD, chief of the medical service at the University of California, San Francisco, who for years has studied patient safety in hospitals, agreed. "We have hit the point where we need to turn our attention to ambulatory care. It has been stuffed to the bottom of the deck so readily because it's so complicated."

While important efforts such as the Institute for Healthcare Improvement's Campaign to Save 100,000 Lives have successfully focused on reducing ventilator-associated pneumonia and central-line infections in hospitals, the problem of how to improve in the outpatient setting where "the patient is a moving target" is underappreciated, Dr. Wachter said.