AHRQ Views

Blog posts from AHRQ leaders

OCT

2016

Taking Steps To Protect Safety in Ambulatory Care

By Richard Ricciardi, Ph.D., N.P., AHRQ Senior Nursing Advisor

Efforts to improve patient safety practices have historically focused on reducing harms in hospitals, such as healthcare-associated infections, falls, and medication errors.

But as the Agency leading national efforts to make health care safer, AHRQ is committed to reducing risks for patients in all settings. That’s why we’re breaking new ground by exploring risk-reduction strategies in another area where patient safety is essential: ambulatory care.

Emblematic of this effort is publication of the AHRQ technical brief Patient Safety in Ambulatory Settings. This comprehensive report explores fundamental questions about patient safety practices in ambulatory care, where over 900 million office visits take place every year. Questions include—

What are the evidence-based hospital patient safety practices that may be applicable to the ambulatory care setting?
What tools, settings, and other factors may influence the implementation and spread of ambulatory care patient safety practices?

Safety issues in ambulatory care settings differ substantively from the hospital setting. Events may be the result of fragmented care or from a delayed or inaccurate diagnosis, a lack of followup on tests, or inappropriate use of two more medications due to deficiencies in medication reconciliation and care coordination.

Complexities inherent in today’s ambulatory care settings can complicate safety efforts. Physicians and nurses may have limited time to see patients, potentially compromising their ability to comprehensively identify and address all medical issues. Electronic health records that exist in diverse formats may be difficult to integrate with problem lists, lab reports, and diagnostic testing results, leading to gaps in followup care.

These challenges and others underscore the need for improved patient safety practices specific to ambulatory settings. AHRQ’s technical brief identifies promising patient safety practices, including which strategies might work best to avoid a delayed or incorrect diagnosis or how clinicians might better engage with patients to lower safety risks.

The brief also suggests that certain models of care, such as implementation of the Patient-Centered Medical Home and optimizing team-based care, may support the implementation and spread of ambulatory care patient safety practices.

Moving forward, AHRQ has funded three studies of promising patient safety practices identified in the technical brief. One will explore the use of health information technology to improve the diagnosis and treatment of pneumonia at the point of care. Another will test a systematic approach to strengthening the efficiency and effectiveness of transferring patient information within and between ambulatory settings. The third will examine "high fidelity" methods to collect and communicate blood and urine test results.

These projects represent important steps toward improving patient safety practices in ambulatory care. But they’re only the beginning—and part of AHRQ’s ongoing efforts to advance the culture of safety and improve patient safety practices in all settings of care.

Page last reviewed October 2016

Internet Citation: Taking Steps To Protect Safety in Ambulatory Care. Content last reviewed October 2016. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/blog/ahrqviews/taking-steps-to-protect-safety.html