Abstract
The outpatient setting, where most medical care is delivered, has unique features with respect to patient safety. Through the cases below we demonstrate the importance of information availability and care transitions, patient self-management skills, and patient–provider communication in addressing patient safety problems in the outpatient setting. Using Wagner’s chronic care model, we describe the health system conditions and patient and provider characteristics that promote safety in ambulatory care.
“Freedom is not worth having if it does not connote freedom to err.”
Mohandas K. Gandhi
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Sarkar U, Wachter RM, Schroeder SA, et al. Refocusing the lens: patient safety in ambulatory chronic disease care. Jt Comm J Qual Patient Saf. 2009;35(7):377–83. 341.
Lorincz C, Drazen E, Sokol P, et al. Research in ambulatory patient safety 2000–2010: a 10-year review. Chicago, IL: American Medical Association; 2011.
Schiff GD, Klass D, Peterson J, et al. Linking laboratory and pharmacy: opportunities for reducing errors and improving care. Arch Intern Med. 2003;163(8):893–900.
The Joint Commission. http://www.jointcommission.org/. Accessed 13 Jul 2013.
Institute of Medicine. To err is human: building a safer health system. Washington, DC: National Academy Press, Institute of Medicine Committee on Quality of Health Care in America; 2000.
Wachter RM. Is ambulatory patient safety just like hospital safety, only without the “stat”? Ann Intern Med. 2006;145(7):547–9.
Sarkar U, Lopez A, Maselli JH, et al. Adverse drug events in U.S. adult ambulatory medical care. Health Serv Res. 2011;46(5):1517–33.
Budnitz DS, Pollock DA, Weidenbach KN, et al. National surveillance of emergency department visits for outpatient adverse drug events. J Am Med Assoc. 2006;296(15):1858–66.
Gandhi TK, Lee TH. Patient safety beyond the hospital. N Engl J Med. 2010;363(11):1001–3.
Woods DM, Thomas EJ, Holl JL, et al. Ambulatory care adverse events and preventable adverse events leading to a hospital admission. Qual Saf Health Care. 2007;16(2):127–31.
Gandhi TK, Kachalia A, Thomas EJ, et al. Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims. Ann Intern Med. 2006;145(7):488–96.
Sarkar U, Handley MA, Gupta R, et al. What happens between visits? Adverse and potential adverse events among a low-income, urban, ambulatory population with diabetes. Qual Saf Health Care. 2010;19(3):223–8.
Budnitz DS, Shehab N, Kegler SR, et al. Medication use leading to emergency department visits for adverse drug events in older adults. Ann Intern Med. 2007;147(11):755–65.
Schillinger D, Wang F, Rodriguez M, et al. The importance of establishing regimen concordance in preventing medication errors in anticoagulant care. J Health Commun. 2006;11(6):555–67.
Schillinger D, Piette J, Grumbach K, et al. Closing the loop: physician communication with diabetic patients who have low health literacy. Arch Intern Med. 2003;163(1):83–90.
Sarkar U, Schillinger D, Bibbins-Domingo K, et al. Patient-physicians’ information exchange in outpatient cardiac care: time for a heart to heart? Patient Educ Couns. 2010;85(2):173–9.
Schillinger D, Barton LR, Karter AJ, et al. Does literacy mediate the relationship between education and health outcomes? A study of a low-income population with diabetes. Public Health Rep. 2006;121(3):245–54.
Sarkar U, Piette JD, Gonzales R, et al. Preferences for self-management support: findings from a survey of diabetes patients in safety-net health systems. Patient Educ Couns. 2008;70(1):102–10.
Peyton L, Ramser K, Hamann G, et al. Evaluation of medication reconciliation in an ambulatory setting before and after pharmacist intervention. J Am Pharm Assoc. 2010;50(4):490–5.
Laiteerapong N, Karter AJ, Liu JY, et al. Correlates of quality-of-life in older adults with diabetes: the diabetes & aging study. Diabetes Care. 2011;34(8):1749–53.
Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358(24):2545–59.
Patel A, MacMahon S, Chalmers J, et al. Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med. 2008;358(24):2560–72.
Forster AJ, Clark HD, Menard A, et al. Adverse events among medical patients after discharge from hospital. CMAJ. 2004;170(3):345–9.
American College of Physicians. The Patient-Centered Medical Home Neighbor: The Interface of the Patient-Centered Medical Home with Specialty/Subspecialty Practices. Philadelphia: American College of Physicians; 2010: Policy Paper.
Singh H, Esquivel A, Sittig DF, et al. Follow-up actions on electronic referral communication in a multispecialty outpatient setting. J Gen Intern Med. 2011;26(1):64–9.
Selby JV, Ray GT, Zhang D, et al. Excess costs of medical care for patients with diabetes in a managed care population. Diabetes Care. 1997;20(9):1396–402.
Kripalani S, Robertson R, Love-Ghaffari MH, et al. Development of an illustrated medication schedule as a low-literacy patient education tool. Patient Educ Couns. 2007;66(3):368–77.
Wolf MS, Davis TC, Curtis LM, et al. Effect of standardized, patient-centered label instructions to improve comprehension of prescription drug use. Med Care. 2011;49(1):96–100.
Casalino LP, Dunham D, Chin MH, et al. Frequency of failure to inform patients of clinically significant outpatient test results. Arch Intern Med. 2009;169(12):1123–9.
Gandhi TK, Sittig DF, Franklin M, et al. Communication breakdown in the outpatient referral process. J Gen Intern Med. 2000;15(9):626–31.
Kripalani S, LeFevre F, Phillips CO, et al. Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA. 2007;297(8):831–41.
Poon EG, Gandhi TK, Sequist TD, et al. “I wish I had seen this test result earlier!”: dissatisfaction with test result management systems in primary care. Arch Intern Med. 2004;164(20):2223–8.
Blumenthal D, Tavenner M. The “meaningful use” regulation for electronic health records. N Engl J Med. 2010;363(6):501–4.
Arcury TA, Preisser JS, Gesler WM, et al. Access to transportation and health care utilization in a rural region. J Rural Health. 2005;21(1):31–8.
Schillinger D, Machtinger EL, Wang F, et al. Language, literacy, and communication regarding medication in an anticoagulation clinic: a comparison of verbal vs. visual assessment. J Health Commun. 2006;11(7):651–64.
Davis TC, Wolf MS, Bass PF, et al. Literacy and misunderstanding prescription drug labels. Ann Intern Med. 2006;145(12):887–94.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2014 Springer Science+Business Media, LLC
About this chapter
Cite this chapter
Sarkar, U. (2014). Patient Safety in Outpatient Care. In: Agrawal, A. (eds) Patient Safety. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7419-7_20
Download citation
DOI: https://doi.org/10.1007/978-1-4614-7419-7_20
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4614-7418-0
Online ISBN: 978-1-4614-7419-7
eBook Packages: MedicineMedicine (R0)