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AMA report concludes more research is needed on patient safety in ambulatory care settings
e-Reports, Feb. 21, 2012
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You promised to “first do no harm” when you became a physician. To help you keep that promise, the AMA has been studying errors in the outpatient setting for 10 years, seeking ways to support all physicians and improve patient safety – outside the hospital.

A new report from the AMA Center for Patient Safety represents a comprehensive look at more than 100 ambulatory patient safety studies, research and initiatives from 2000 to 2010. Major gaps were discovered in the medical profession’s understanding of ambulatory safety, highlighting a need for additional studies to show ways to improve outpatient care.

“Patient safety in all health care settings is the highest priority for physicians,” AMA President Peter W. Carmel, M.D., told American Medical News. “The AMA is pleased to add our new report to the discussion on this critical topic, which is especially timely, as ambulatory care will play an increasingly important role in optimizing quality and cost in new health care delivery models.”

To date, no nationwide estimate exists of the number of patients harmed or killed by mistakes in the outpatient setting, in contrast to the hospital setting. This is quite an oversight considering ambulatory care patient visits outnumber hospital admissions by 300 to 1.

Given the lack of information, the report concludes research in ambulatory safety deserves more attention and should be the focus of patient safety research during the next decade. Examinations should include medication safety, diagnostic errors, office-based surgery and anesthesia, the patient role in care and communication safety.

Below are the top six types of errors documented in the ambulatory setting, according to the new AMA report, "Research in Ambulatory Patient Safety 2000-2010: A 10-year review."

Find the complete report on the AMA website.

Top Six Errors
  • Medication errors such as prescriptions for incorrect drugs or incorrect dosages. Drugs in widespread use and those with a narrow therapeutic range and high toxicity are most frequently associated with identified adverse events and medication errors. The advancing age of patients and increasing numbers of medications and co-morbidities are associated with increased risk of experiencing a medication error and an adverse event.
  • Diagnostic errors such as missed, delayed and wrong diagnoses. Diagnostic errors were a more frequent reason for malpractice claims in outpatient care than medication errors. Cancer is the disease most commonly associated with a diagnostic error.
  • Laboratory errors such as missed, delayed and wrong diagnoses.
  • Clinical knowledge errors such as knowledge, skill and general performance errors on the part of physicians and other clinicians.
  • Communication errors such as physician/patient communication errors, physician/physician communication errors or other miscommunications between parties.
  • Administrative errors such as errors in scheduling appointments and managing patient records.
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