Advancing Patient Safety Beyond the Hospital

Patient Safety Awareness Week begins this week, a time to recognize the importance of patient safety in every setting where health services are provided.  It’s also a time to remind ourselves—health professionals, health organizations, patients, and families—of the vital role each of us plays in making sure that every health care encounter is a safe one.  

As the Nation’s patient safety agency, AHRQ is a strong supporter of this annual event led by the Institute for Healthcare Improvement (IHI). This year, we’ll be focusing on how to make care safer in ambulatory settings, or the varied places where services are provided outside of hospital walls.

The number of outpatient services offered today is estimated to be three times as high as inpatient services. AHRQ data supports this trend: nearly half (49 percent) of the 19 million surgeries performed in 2012 were performed on an outpatient basis, a portion that’s projected to be even higher today.

AHRQ has devoted a growing share of its funding and technical support to the unique safety challenges in care provided outside of the hospital. Some of the resources derived from these investments provide evidence-based, practical guidance on how to make ambulatory care safer: 

• Toolkit to Engage High-Risk Patients in Safe Transitions Across Ambulatory Settings: Patients with complicated care needs or other risk factors can be more vulnerable to patient safety gaps, and these patients can gain substantial benefits from help in preparing for their medical appointments.  This toolkit gives providers what they need to engage and prepare these patients for new appointments.
• Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families:  When providers work in partnership with patients, health care encounters are safer.  This guide helps primary care practices with practical strategies about how to do this and ensure safer, higher quality care.
• Improving Your Laboratory Testing Process: A Step-by-Step Guide for Rapid-Cycle Patient Safety and Quality Improvement: Up to 40 percent of patient encounters in primary care offices involve some type of medical test.  This guide can help primary care offices increase the reliability of their laboratory testing process.

As helpful as these tools are, we know there are many more safety-related challenges that need to be addressed. That’s why we’re continuing to invest in research that’s targeting challenges in outpatient settings, such as the need to improve diagnosis.  AHRQ has supported research on this topic for several years now, and we were encouraged to receive additional funds for it as part of the annual budget process.  This new funding will enable additional support for researchers who want to better understand why diagnostic errors occur and how we can prevent them. 

We’re also making progress toward the goal of safer care by working with several stakeholders in the field on the National Steering Committee for Patient Safety.  I’m honored to co-chair this group with my colleague, Tejal Gandhi, M.D., M.P. H., who is IHI’s Chief Clinical and Safety Officer.

The steering committee is at work developing a national action plan that will guide patient safety efforts in a coordinated manner.  Both our approach and the people and organizations involved in this effort reflect a broader, system-wide approach to safety.  Our shared work to date is underscoring the need for “foundational factors” that must be present to ensure that safety is both effectively and efficiently integrated into practice.  Those factors for success are: attention to the role of organizational culture and leadership, the ability to continually learn and improve (learning health systems), active engagement of patients and families in care, and ensuring the safety and well-being of the health care workforce.  You’ll hear more in the months ahead about our efforts as we work to refine these concepts and learn how to operationalize them in the pursuit of patient safety.

This is an exciting time to be involved in patient safety research and implementation. Patient Safety Awareness Week reminds us that because we’re all patients, this work has the potential to have a positive impact on everyone. 

Dr. Brady is the Director of AHRQ’s Center for Quality Improvement and Patient Safety.

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