Errors in diagnostic tests and medication safety events pose the
biggest risk to patients in ambulatory care settings, according to a new
analysis.
Those two errors are the most frequent safety risks in ambulatory care, a
report (PDF) from the ECRI Institute, an independent nonprofit organization, found.
The analysis was based on 4,355 adverse events reported to the
institute by physician practices, ambulatory care centers and community
health centers between December 2017 and November 2018. Nearly half of
the events involved diagnostic testing errors; a quarter involved
medication safety, and the rest involved falls, security and safety and
privacy-related risks, the institute reported.
Approximately half of all events reported occurred in physician practices.
“As healthcare delivery shifts from hospitals to ambulatory care
settings, it can be challenging to coordinate care among various
clinicians, systems and facilities, raising the potential for errors
that put patients at risk,” Marcus Schabacker, M.D, president and CEO of
the ECRI Institute, said in a
statement.
“Reducing and eliminating adverse events in an outpatient environment
will require an unprecedented commitment to collaboration and
coordination,” he said.
Here are the five key types of safety problems occurring in
ambulatory care settings, the largest and most widely used segment of
the healthcare system:
Diagnostic testing errors. Errors that occur during
diagnostic testing
can have potentially devastating consequences for patients, the report
noted. The majority of this kind of error involved laboratory tests.
Other tests where problems occurred included imaging tests, pathology
and cardiology. Diagnostic errors are the leading cause of liability
claims against primary care doctors and account for the highest
proportion of payouts, according to a Coverys report released earlier
this year. Practices and health centers can improve by providing
decision support tools to help providers order the proper tests and
monitoring processes for test tracking and follow-up.
Medication safety events. Two-thirds of the analyzed
medication safety events were classified as wrong drug, wrong patient
or wrong time, the analysis found.
Medication errors
are a leading cause of malpractice claims in ambulatory care and can
occur during any stage of the medication process. They are often the
result of a series of failures within a system, the report said.
Practices and centers should implement standardized medication
management procedures and create a policy directing how to report and
manage safety events.
Falls. Approximately 800,000 people will be
hospitalized each year with a fall-related injury. Half of the falls in
ambulatory settings that ECRI analyzed occurred in the exam room or
waiting room. Practices and health centers should screen patients for
fall risk at every visit, when a change in condition occurs and after a fall and should proactively identify patients at high risk.
HIPAA violations. Misunderstandings concerning HIPAA
privacy and security rules prompted more than 350 HIPAA-related events
to be reported to the ECRI Institute. The majority of these pertained to
inadvertent
disclosure of patients’ protected health information.
Security and safety incidents. The vast majority of
events involved verbal threats or disruptive behavior by patients or
visitors. Practices need to educate staff on what to do in the event of a
violent incident and conduct monthly security and safety surveillance rounds, the report recommended.
https://www.fiercehealthcare.com/practices/5-biggest-risks-ambulatory-care-needs-to-address-according-to-ecri-institute-analysis
