Skip to main content

Patient Safety in Outpatient Care

  • Chapter
  • First Online:
Patient Safety

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

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. 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.

    PubMed  Google Scholar 

  2. 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.

    Google Scholar 

  3. 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.

    Article  PubMed  Google Scholar 

  4. The Joint Commission. http://www.jointcommission.org/. Accessed 13 Jul 2013.

  5. 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.

    Google Scholar 

  6. Wachter RM. Is ambulatory patient safety just like hospital safety, only without the “stat”? Ann Intern Med. 2006;145(7):547–9.

    Article  PubMed  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. 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.

    Article  CAS  Google Scholar 

  9. Gandhi TK, Lee TH. Patient safety beyond the hospital. N Engl J Med. 2010;363(11):1001–3.

    Article  PubMed  CAS  Google Scholar 

  10. 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.

    Article  PubMed  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. 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.

    Article  PubMed  Google Scholar 

  13. 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.

    Article  PubMed  Google Scholar 

  14. 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.

    Article  PubMed  Google Scholar 

  15. 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.

    Article  PubMed  Google Scholar 

  16. 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.

    Article  PubMed  Google Scholar 

  17. 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.

    PubMed  Google Scholar 

  18. 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.

    Article  PubMed  Google Scholar 

  19. 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.

    Article  Google Scholar 

  20. 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.

    Article  PubMed  Google Scholar 

  21. 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.

    Article  PubMed  CAS  Google Scholar 

  22. 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.

    Article  PubMed  CAS  Google Scholar 

  23. Forster AJ, Clark HD, Menard A, et al. Adverse events among medical patients after discharge from hospital. CMAJ. 2004;170(3):345–9.

    PubMed  Google Scholar 

  24. 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.

    Google Scholar 

  25. 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.

    Article  PubMed  Google Scholar 

  26. 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.

    Article  PubMed  CAS  Google Scholar 

  27. 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.

    Article  PubMed  Google Scholar 

  28. 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.

    Article  PubMed  Google Scholar 

  29. 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.

    Article  PubMed  Google Scholar 

  30. Gandhi TK, Sittig DF, Franklin M, et al. Communication breakdown in the outpatient referral process. J Gen Intern Med. 2000;15(9):626–31.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  32. 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.

    Article  PubMed  Google Scholar 

  33. Blumenthal D, Tavenner M. The “meaningful use” regulation for electronic health records. N Engl J Med. 2010;363(6):501–4.

    Article  PubMed  CAS  Google Scholar 

  34. 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.

    Article  PubMed  Google Scholar 

  35. 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.

    Article  PubMed  Google Scholar 

  36. Davis TC, Wolf MS, Bass PF, et al. Literacy and misunderstanding prescription drug labels. Ann Intern Med. 2006;145(12):887–94.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Urmimala Sarkar M.D., M.P.H. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints 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)

Publish with us

Policies and ethics