Addressing Ambulatory Patient Safety in Your Practice


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Reducing errors in care requires establishing a culture of safety, systematic reporting, consistent follow-up, and sustained commitment.

Fam Pract Manag. 2015 Sep-Oct;22(5):23-28.

Author disclosure: no relevant financial affiliations disclosed.

Do no harm. It is the bedrock principle of medical practice and the first priority for any medical practitioner. However, the Institute of Medicine, in its ground-breaking “To Err Is Human” study, showed that the medical community is not living up to this important principle. The study estimated that up to 98,000 people die annually in United States hospitals because of preventable medical errors.1

Subsequent studies have increased that estimate, and health care leaders, regulators, and insurers have crusaded for a renewed focus on improving patient safety.2 While advances such as electronic prescribing have helped to improve outpatient safety, the majority of effort and research has been dedicated to inpatient safety. 3

Errors in the inpatient setting tend to be acutely recognized, but outpatient care is equally hazardous, generating more than half of all paid malpractice claims and two-thirds of claims involving major injury or death, according to one study.4

Our University of Washington-affiliated community hospital outside Seattle chose several years ago to focus on patient safety in its outpatient clinic network, which includes 224 physicians in more than 30 locations. We developed and implemented a program for detecting, identifying, and addressing safety problems in our clinics that could be pursued by practices of all sizes.

Safety and quality are not the same

Patient safety is obviously a key facet of how well you care for the patient. For this reason, many institutions have ambulatory quality committees that also consider safety. However, we have found these committees tend to spend more time on measuring quality than analyzing safety issues. Some institutions have recognized this and formed safety committees, but we find these committees typically combine both inpatient and outpatient safety and, for the reasons described earlier, outpatient safety gets overshadowed.

Ambulatory patient safety should have its own committee and dedicated focus. We began our initiative by creating precisely this type of group.

Every person working in the clinic has a role in patient safety, so the ideal committee should have representatives of every job role, including a front-desk worker, medical assistant, registered nurse, physician, pharmacist (if you have one in-house), laboratory technician, etc. If you have more than one clinic, make sure to have representatives from each on the committee. Practical concerns may limit the size of your committee, but it is important to aim for broad representation.

Building a culture of safety

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About the Authors

Dr. Park is associate medical director for the clinical network of Valley Medical Center in Renton, Wash., and is a practicing family physician.

Author disclosure: no relevant financial affiliations disclosed.



show all references

1. Kohn, LT, Corrigan, JM, and Donaldson MS, eds., for the Committee on Quality of Health Care in America, Institute of Medicine. To Err Is Human: Building a Safer Health System. Washington, DC: National Academies Press; 1999....

2. James JT. A new, evidence-based estimate of patient harms associated with hospital care. J Patient Saf. 2013;9(3):122–128.

3. Wynia MK, Classen DC. Improving ambulatory patient safety: learning from the last decade, moving ahead in the next. JAMA. 2011;306(22):2504–2505.

4. Bishop TF, Ryan AM, Casalino LP. Paid malpractice claims for adverse events in inpatient and outpatient settings. JAMA. 2011;305(23):2427–2431.

5. Marx D. Patient Safety and the “Just Culture”: A Primer for Health Care Executives. New York, NY: Columbia University; 2001.


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