Patient Safety beyond the Hospital

Originally posted 9-21-2010:
As I have been writing this blog and reading up on Patient Safety research, I have noticed that much of the work has been done for hospital settings.  This makes a lot of sense, as the most critically ill patients and most intensive procedures occur in inpatient settings.  However, most patients do not get admitted to the hospital. Instead, a majority of patients are seen in an outpatient setting - primary care clinics, same day surgeries, or even a visit to the local pharmacy.  But as I recently wrote, a medical error can occur outside of the hospital walls.

That's why I found this recent New England Journal of Medicine article by Drs. Gandhi and Lee to be very interesting.  The article focuses on the lack of Patient Safety research in ambulatory care settings and addresses some of the safety challenges in that healthcare environment. 

One of the main takeaways is the lack of information sharing that goes on between different care settings.  These days a patient could be seeing a couple specialists, but none of them may be aware of the care and treatment from the other physicians.  As Electronic Health Records (EHRs) are mentioned more and more for hospitals, I hope health systems are also looking at including them in their clinics so there are not any information disconnects in patient care.

Additionally, the article mentions "an increasing number of complex procedures are now being performed as day surgery or in nonhospital locations."  Because of this increase in the amount of day surgery centers, it is getting on the radar of HHS to look at ways to reduce Healthcare Associated Infections (HAIs) in these settings.  The attached .pdf was a presentation from the NPSF conference, and it is clear that initiatives for HAI reduction in ambulatory settings is on the horizon.

I was also glad to see the article highlight the need for patients to get involved in their own care.  Some healthcare systems have developed "innovative approaches to engaging patients in their own care."  The primary example are the health record portals in which patients can view their own test results, view their medications, and monitor their care.  I have written on here before that patients need to be part of the feedback loop to prevent a medication error from causing harm.  This is even more important in the ambulatory care setting where a care giver is not monitoring the patient on a regular basis.

Finally, I was happy to see the authors highlight the need for the ambulatory setting to embrace a culture of safety.  Creating a culture of safety has been identified as one of the biggest, but most important challenges to improving Patient Safety.  Culture change has been a common theme in much of what I have across in my Patient Safety research, from attending the NPSF conference to reading books such as "Why Hospitals Should Fly". 

Overall, this article was a good read and provides a nice way to raise awareness that safety issues can occur in any aspect of healthcare.  It seems that we are only seeing the tip of the iceberg in making changes to improve the safety of the ambulatory care environment.