According to a recently published study, over the past decade, there has been a dearth of funding aimed at improving the care patients receive during outpatient visits. This is especially important, because ambulatory care patient visits outnumber hospital admissions by 300 to 1. Despite these numbers, over 50% of all medical malpractice settlements are for adverse events that occurred in outpatient (office) settings. What’s more, over 65% of those cases involved “major” injuries or death.
According to the American Medical Association’s Center for Patient Safety, the most common errors committed in outpatient or office settings include incorrect prescribing of medications, misdiagnoses, failing to report test results, and poor communication. (For example, according to a 2009 study published in the Archives of Internal Medicine, office-based physicians failed to follow up on clinically meaningful test results almost 8% of the time.) The AMA’s website quoted Matthew K. Wynia, M.D., M.P.H. as saying that missed test results “should never happen.” Dr. Wynia further stated, “You ordered the test. Why did you order the test if you weren’t going to do something with the result? It’s almost like a never event. If you’re going to order the test, then what you’re going to do with the result needs to be clear.”
In the Journal of the American Medical Association‘s December 14, 2011 issue, a commentary co-authored by Dr. Wynia concluded that more research must be performed to determine why so many errors are committed in outpatient-based settings, and the total number of mistakes that have occurred. To date, no definitive studies have been performed to determine the number of preventable mistakes committed in outpatient settings. However, according to a 1999 study, as many as 98,000 Americans die every year in hospital settings due to malpractice. One can only assume that based upon the disparity between the number of office visits and hospital admissions, the number of Americans who die annually from medical mistakes committed in outpatient settings may be as high as 250,000. The AMA website also quoted David C. Classen, M.D., who co-authored the aforementioned commentary with Dr. Wynie, as saying, “Nailing down the incidence [of outpatient care errors] is the only way you can measure whether all these interventions are really leading to any improvements. There are a lot of evangelical beliefs in patient safety – that if we just do this, it will get better. But it won’t get better if we don’t have any reliable way to measure.”
The AMA should be congratulated on recognizing that more must be done to improve the care patients receive in outpatient settings. However, before any meaningful steps can be made, there must be adequate funding to study why so errors are being committed, and what healthcare providers can do to prevent making those errors again and again.
Read more about the issue of ambulatory care errors on the AMA website: http://www.ama-assn.org/amednews/2012/01/09/prl10109.htm
The full text of Drs. Wynie and Classen’s recent commentary can be found here: http://jama.ama-assn.org/content/306/22/2504.extract
