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AMA Calls for Review of Ambulatory Care Procedures

Patient in exam room with doctor

In December of last year, the American Medical Association (AMA) released a report detailing the lack of attention paid to patient safety hazards at hand during ambulatory care. In a January 9 follow-up release to that report, the AMA announced that several health leaders are backing their previous claims.

“There has been a broad recognition that research on ambulatory safety is desperately needed,” said Matthew Wynia, MD of the AMA Center for Patient Safety. “Each year, far more patients receive care as outpatients than as inpatients, and errors in ambulatory settings can be just as devastating as those in hospitals.”

In 1999, the Institute of Medicine released a report highlighting the necessary steps for improving inpatient care. That report spurred a trail of studies and initiatives related to improving trends of medical errors at hospitals, which has since improved significantly.

“The main problem here is that in the rapidly changing health care world, unless something is viewed as really critical, it will not rise to the top of the list of priorities,” says Dr. David Classen, MD. “Nailing down the incidence is the only way you can measure whether all these interventions are really leading to any improvements.”

Now, the focus is back on outpatient procedures and ambulatory care.

“While much has been learned from inpatient patient safety efforts, it is unclear whether the lessons learned can be applied to ambulatory care settings,” the report reads. “Ambulatory care settings are different than inpatient care facilities in a number of important ways.”

Medication errors, diagnostic errors, laboratory errors, and clinical knowledge errors are among the most commonly occurring errors made during outpatient care. Also in this list are communication and administrative errors, such as miscommunication between the doctor and patient, or appointment scheduling and management of patient records.

“Many studies examining errors in the ambulatory setting included both errors causing harm and those where no harm was suffered,” the authors of the report added. “Very few included an assessment of which errors could have been prevented.”

Because ambulatory care visits outnumber hospital admissions 300:1, Wynia and his associates are pushing for action in the near future. Wynia and Classen recommend additional research to identify additional safety risks and lapses, along with the engagement of patients’ families.

“While we conclude that ambulatory safety should be a focus of much more research on patient safety in the next decade, this report also brings attention to the critical contributions to our understanding of ambulatory safety that have been made by a large number of researchers,” Wynia adds.

Wynia concludes his introduction to the report with a call to “help the medical profession live up to our ancient credo: First, do no harm.”

If you have any experiences in either outpatient or inpatient care relating to this article, share them in the comment box below.

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