IHI 2017: Patient safety efforts must move beyond the hospital to encompass ambulatory, home settings

Pregnant woman getting checkup
Patient safety initiatives have primarily focused on hospitals, but it's time to expand best practices to other areas as hospitals shift care to outpatient settings, says Tejal Gandhi, M.D. (Getty/byryo)
Tejal Gandhi
Tejal Gandhi

ORLANDO, Fla.—Patient safety efforts have come a long way since the publication of the 1999 landmark report, “To Err is Human: Building a Safer Health System.” But they're still a work in progress.

Although hospitals have seen declines in medication errors, hospital-acquired infection rates and readmissions, it's time to focus on settings such as primary care practices, ambulatory surgical centers, dialysis and home settings, said Tejal Gandhi, M.D., chief clinical and safety officer at the Institute for Healthcare Improvement, during a press briefing Monday at the organization’s 29th annual National Forum on Quality Improvement in Healthcare.

“I’m asked a lot, ‘are we safer than we were back in 1999?’ and experts in the field say 'yes' because of activity that didn’t exist 20 years ago,” said Gandhi, noting that hospitals now have patient safety teams, and established education and training programs.

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But those patient safety initiatives must now expand to other areas, especially as hospitals shift care to outpatient settings, she said.

The American College of Physicians also supports that call to action. In a recent paper, the organization offered a set of recommendations to improve patient safety in office-based practices.

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The IHI, an independent, not-for-profit organization focused on healthcare improvement, aims to drive the patient safety movement. The organization recently merged with the National Patient Safety Foundation and aims to be a leader in patient safety. One of the first actions the organizations took after they joined forces was a call to action that declared patient safety a public health issue.

Gandhi said the IHI is working on a strategic plan to advance the patient safety agenda, which will focus on leadership and culture.

The organization is looking for new ways to engage boards and CEOs through education and certifying professionals in patient safety. It's also developing new best practices in patient safety to include the care provided in patients’ homes, a setting they charge has been ignored.

There is also a need to address diagnostic errors, a patient safety concern that wasn’t mentioned in the To Err is Human report. Recent research finds that 20% of patients who sought a second opinion from specialists were misdiagnosed by primary care providers.

Gandhi said that developing best practices to reduce these errors will be a big challenge because it doesn’t just involve managing test results. The issue also includes cognitive errors made when someone didn’t think to order a test or was too tired, busy or distracted to catch the errors, she said.