ambulatory care patient safety: environmental scan report.

What do we know about patient safety in ambulatory care?

However, a body of research dedicated to patient safety in ambulatory care has emerged over the past few years. These efforts have identified and characterized factors that influence safety in office practice, the types of errors commonly encountered in ambulatory care, and potential strategies for improving ambulatory safety.

What are the steps involved in the environmental scan?

The environmental scan consisted of the following four primary steps: Define patient safety. Identify sources of information. Determine inclusion. Track results.

How does air identify patient safety programs?

During the environmental scan, AIR identified patient safety programs, using publicly available sources. The purpose of this step was to identify a comprehensive set of programs that met predetermined inclusion criteria and collect similar information about each of the programs to enable a standardized presentation in an electronic catalog.

What information sources are used in the environmental scan process?

We targeted two types of information sources during the environmental scan process: (1) peer-reviewed literature; and (2) Internet and grey literature for prior, new, and existing patient safety efforts.

What are the National Patient Safety Goals?

Although efforts to improve safety have largely focused on hospital care, The Joint Commission now publishes National Patient Safety Goals focused on ambulatory care. The Agency for Healthcare Research and Quality is also leading efforts to improve ambulatory quality and safety through programs and research funding. A 2016 systematic review commissioned by the World Health Organization identified missed and delayed diagnoses and medication errors as the chief safety priorities in ambulatory care, and it highlighted the need to develop clear and consistent definitions for patient safety incidents in primary care.

How can EHRs improve outpatient safety?

Improving outpatient safety will require both structural reform of office practice functions as well as engagement of patients in their own safety. While EHRs hold great promise for reducing medication errors and tracking test results, these systems have yet to reach their full potential. Coordinating care between different physicians remains a significant challenge, especially if the doctors do not work in the same office or share the same medical record system. Efforts are being made to increase use of EHRs in ambulatory care, and physicians believe that use of EHRs leads to higher quality and improved safety.

Does the Joint Commission publish patient safety goals?

Although efforts to improve safety have largely focused on hospital care, The Joint Commission now publishes National Patient Safety Goals focused on ambulatory care. The Agency for Healthcare Research and Quality is also leading efforts to improve ambulatory quality and safety through programs and research funding.

Is ambulatory care an outpatient setting?

Despite the fact that the vast majority of health care takes place in the outpatient, or ambulatory care, setting, efforts to improve safety have mostly focused on the inpatient setting. However, a body of research dedicated to patient safety in ambulatory care has emerged over the past few years.

Define Patient Safety

As a preliminary step in the refinement of the environmental scan methodology, we conducted a literature review to identify various definitions of patient safety from reputable sources, including books, scholarly journals, Federal Government agency reports, and organizational resources.

Identify Sources of Information

We targeted two types of information sources during the environmental scan process: (1) peer-reviewed literature; and (2) Internet and grey literature for prior, new, and existing patient safety efforts.

Exhibit 3. Databases to be Used in the Environmental Scan

As with peer-reviewed literature, we used the pre-identified set of uniform keyword search terms that were keyed in a variety of search engines listed in Exhibit 4 to search the Internet.

Determine Inclusion

Once a program was identified, we then applied a set of inclusion criteria to ensure only relevant programs would be fully abstracted and documented in the final catalog. AIR, in collaboration with AHRQ, identified the following inclusion criteria.

Results of Environmental Scan

The environmental scan yielded a total of 821 potential patient safety programs. The team tended to err on the side of inclusion for programs with limited information available at the time of the scan because each program would be reviewed more thoroughly during data abstraction.

Track Results

AIR developed a Microsoft Excel worksheet to document possible patient safety education and training.

Background

Factors Influencing Safety in Ambulatory Care

• Ensuring patient safety outside of the hospital setting poses unique challenges for both providers and patients. A recent article proposed a model for patient safety in chronic disease management, modified from the original Chronic Care Model. This model broadly encompasses three concepts that influence safety in ambulatory care: 1. The role of pat...

See more on psnet.ahrq.gov

Types of Safety Events in Ambulatory Care

Improving Safety in Ambulatory Care

Current Context