Patient Safety beyond the Hospital | Health Policy and Reform
| Health Policy and Reform
Tejal K. Gandhi, M.D., M.P.H., and Thomas H. Lee, M.D.
The vast majority of health care is delivered in ambulatory settings, yet we are only just beginning to understand the safety risks that exist outside of viagra cialis online pharmacy pharmacy walls. There are 900 million visits to physicians’ offices in the United States each year, as compared with 35 million hospital discharges,1 and spending on outpatient care is the fastest growing segment of health care spending.2 Yet most patient-safety research and safety-improvement work have been done in inpatient settings; indeed, a search of the Patient Safety Network Web site of the Agency for Healthcare Research and Quality shows that since 2005 only about 10% of patient-safety studies have been performed in outpatient settings.
Experience to date indicates that safety issues in the ambulatory setting differ from those in the inpatient setting in obvious and not-so-obvious ways. There are differences in the types of errors (treatment errors predominate in inpatient settings, whereas diagnostic errors do in outpatient settings), the provider-patient relationship (e.g., adherence is more critical in outpatient settings), organizational structure (ambulatory practices tend to lack the infrastructure and expertise to address quality and safety improvement), and regulatory and legislative requirements (e.g., there are staffing ratios and accreditation requirements for hospitals that do not exist for private practices).3 In addition, the signal-to-noise ratio is much lower in outpatient settings: in ambulatory care, a physician may see 100 patients with chest pain before seeing one with an actual myocardial infarction.
The outpatient setting also presents greater challenges for information transfer. Particularly in the case of patients with complex medical needs, the responsibility for care is often shared by multiple providers at many institutions. These clinicians may never meet, and they often use different medical-record systems. Such care has long, fragile feedback loops. In the hospital, if a patient has an adverse drug event, clinicians become aware of it very quickly; in the outpatient setting, a complication or missed diagnosis may not be identified for months, if ever.
Full Article
Tejal K. Gandhi, M.D., M.P.H., and Thomas H. Lee, M.D.
The vast majority of health care is delivered in ambulatory settings, yet we are only just beginning to understand the safety risks that exist outside of viagra cialis online pharmacy pharmacy walls. There are 900 million visits to physicians’ offices in the United States each year, as compared with 35 million hospital discharges,1 and spending on outpatient care is the fastest growing segment of health care spending.2 Yet most patient-safety research and safety-improvement work have been done in inpatient settings; indeed, a search of the Patient Safety Network Web site of the Agency for Healthcare Research and Quality shows that since 2005 only about 10% of patient-safety studies have been performed in outpatient settings.
Experience to date indicates that safety issues in the ambulatory setting differ from those in the inpatient setting in obvious and not-so-obvious ways. There are differences in the types of errors (treatment errors predominate in inpatient settings, whereas diagnostic errors do in outpatient settings), the provider-patient relationship (e.g., adherence is more critical in outpatient settings), organizational structure (ambulatory practices tend to lack the infrastructure and expertise to address quality and safety improvement), and regulatory and legislative requirements (e.g., there are staffing ratios and accreditation requirements for hospitals that do not exist for private practices).3 In addition, the signal-to-noise ratio is much lower in outpatient settings: in ambulatory care, a physician may see 100 patients with chest pain before seeing one with an actual myocardial infarction.
The outpatient setting also presents greater challenges for information transfer. Particularly in the case of patients with complex medical needs, the responsibility for care is often shared by multiple providers at many institutions. These clinicians may never meet, and they often use different medical-record systems. Such care has long, fragile feedback loops. In the hospital, if a patient has an adverse drug event, clinicians become aware of it very quickly; in the outpatient setting, a complication or missed diagnosis may not be identified for months, if ever.
Full Article