New research from ECRI Institute reveals that diagnostic testing and medication events are the most frequent safety risks patients face in ambulatory care. ECRI Institute’s Deep Dive: Safe Ambulatory Care, Strategies for Patient Safety & Risk Reduction identifies solutions for five key types of safety challenges occurring in ambulatory care, the largest and most widely used segment of the healthcare system.

ECRI Institute analyzed 4,355 adverse events reported 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; the rest involved falls; security and safety; and privacy-related risks.

“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,” says Marcus Schabacker, MD, PhD, president and CEO of ECRI Institute. “Reducing and eliminating adverse events in an outpatient environment will require an unprecedented commitment to collaboration and coordination.”

The adverse events analyzed in ECRI Institute’s report included:

  • Diagnostic testing errors: Errors that occur during diagnostic testing can have potentially devastating consequences for patients. The majority of these errors involved laboratory tests. Solutions include providing decision support tools to providers 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. Medication errors are a leading cause of malpractice claims in ambulatory care. They can occur during any stage of the medication process, and are often the result of a series of failures within a system. Solutions include implementing standardized medication management procedures and creating 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 events ECRI analyzed occurred in the exam room or waiting room. Solutions include screening for falls and proactively identifying patients at high risk.
  • HIPAA violations: Misunderstanding concerning Health Insurance Portability and Accountability Act (HIPAA) privacy and security rules prompted more than 350 HIPAA-related events to be reported to ECRI Institute. The majority of these pertained to an 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. Solutions include educating staff on what to do in a violent incident and conducting monthly security and safety surveillance rounds.