The 5 biggest risks ambulatory care needs to address, according to ECRI Institute analysis

Radiology xray doctor diagnostics testing
Diagnostic testing errors pose the biggest risk to patients in ambulatory care settings, according to an ECRI Institute analysis. (Pixabay)

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.

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“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.