Patient Safety: A Perspective from Office Practice.
Baron RJ. AHRQ WebM&M [serial online]. May 2009.
Most patient interactions with the health care system occur in the outpatient setting. Many potential and actual safety problems occur there as well. Yet patient safety literature and practice do not seem to have reached deeply into ambulatory care. This is likely due to a combination of factors: in most practices, there is no layer of administration providing a second look at routine policies and procedures; there is no accrediting agency, like The Joint Commission, to mandate safe practices; and those of us in office practice are so consumed with simply getting through the day that it is difficult to recognize the problems, large and small, that can lead to major safety hazards. The business case for safety, such as it is, relies almost entirely on the malpractice rate-setting process: errors that result in litigation lead to higher premiums and personal and professional misery. However, as Studdert has argued, relying on the malpractice system to identify and "correct" errors is unlikely to be timely or productive.
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Recurrent Hypoglycemia: A Care Transition Failure?
Eytan T. AHRQ WebM&M [serial online]. October 2008.
Errors of diagnosis in pediatric practice: a multisite survey.
Singh H, Thomas EJ, Wilson L, et al. Pediatrics. 2010;126:70-79.
Trends in primary care clinician perceptions of a new electronic health record.
El-Kareh R, Gandhi TK, Poon EG, et al. J Gen Intern Med. 2009;24:464-468.
Creating a better discharge summary: improvement in quality and timeliness using an electronic discharge summary.
O'Leary KJ, Liebovitz SM, Feinglass J, et al. J Hosp Med. 2009;4:219-225.
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Setting of Care
Ambulatory Clinic or Office
Health Care Providers
Discontinuities, Gaps, and Hand-Off Problems
Medication Errors/Preventable Adverse Drug Events
Approach to Improving Safety
Communication between Providers
Laboratory Result Tracking Improvement
Electronic Health Records
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