Chartbook on Patient Safety

Patient Safety in the Ambulatory Setting

• Although patient safety initiatives usually focus on inpatient hospital events, adverse effects of medical care may be identified and treated in outpatient settings.
• Adverse effects of medical care can follow care or procedures in hospitals, emergency departments (EDs), physician offices, or other settings.
• Measures include:
  • Adults with a probable missed stroke in the emergency department.
  • Adults age 65 and over who received potentially inappropriate prescription medications during the calendar year.

Missed Stroke in the Emergency Department

Adults with a probable missed stroke in the emergency department, by age, 2009

Source: Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project, State Inpatient Databases, 2009, and State Emergency Department Databases, 2008-2009, pooled data for nine States (AZ, FL, MA, MO, NH, NY, SC, TN, and UT).

Note: For this measure, missed stroke is defined as a patient hospitalized for stroke who was treated and released from the ED within the prior 30 days with any diagnosis except cerebrovascular disease. For more details, see Newman-TokerDE, Moy E, Valente E, et al. Missed diagnosis of stroke in the emergency department: a cross-sectional analysis of a large population-based sample. Diagnosis 2014;1(2):155-66. http://www.degruyter.com/dg/viewarticle.fullcontentlink:pdfeventlink/$002fj$002fdx.2014.1.issue-2$002fdx-2013-0038$002fdx-2013-0038.pdf?t:ac=j$002fdx.2014.1.issue-2$002fdx-2013-0038$002fdx-2013-0038.xml. 

• Importance: Misdiagnosis of conditions in patients who seek care from the ED may result in death or disability.
• Overall Rate: In 2009, the percentage of adults with a probable missed stroke in the ED was 1.2%.
• Groups With Disparities: In 2009, patients ages 18-44 years were at the highest risk of being hospitalized for stroke within 30 days of being treated for dizziness or headache in the ED and subsequently released, compared with all other age groups. The likelihood of a missed stroke diagnosis decreased as patient age increased.

Inappropriate Prescription Medications

Adults age 65 and over who received potentially inappropriate prescription medications during the calendar year, by race/ethnicity and family income, 2002-2012

Left Chart

Right Chart

Source: Agency for Healthcare Research and Quality, Medical Expenditure Panel Survey, 2002–2012.

Note:  For this measure, lower rates are better. Prescription medications received include all prescribed medications initially purchased or otherwise obtained as well as any refills. White and Black are non-Hispanic. Hispanic includes all races. For more information on inappropriate medications, see The American Geriatrics Society 2012 Beers Criteria Update Expert Panel.American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2012 Apr;60(4):616-31. 

• Importance: Some drugs that are prescribed for older patients are known to be potentially harmful for this age group.
• Change Over Time:
  • From 2002 to 2012, the percentage of adults age 65 years and over who received potentially inappropriate prescription medications decreased overall and for all racial and ethnic groups and all income groups.
  • Poor adults had the largest decrease in the percentage who received potentially inappropriate medications (from 23% in 2002 to 11% in 2012).

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