Improving patient safety in office-based practices

By Michael H. Broder, PhD
Published December 4, 2017

Key Takeaways

A 28-year-old man presented to his primary care physician with intermittent rectal bleeding. The physical exam revealed no hemorrhoids, but the patient’s fecal occult blood test was positive. Fifteen subsequent office visits later—28 months after his initial primary care visit—the patient was finally referred to a gastroenterologist, who diagnosed him with rectal carcinoma. 

Failure-to-diagnose cases—such as the one above, reported in JAMA Internal Medicine—accounted for 72% of all malpractice claims in primary care, half of which turn out to involve cancer, reported researchers in a study of malpractice suits in Massachusetts.

Medical errors are the third-leading cause of death in the United States, responsible for more than 251,000 deaths each year, according to a study by researchers at the Johns Hopkins University School of Medicine, Baltimore, MD.

Errors in outpatient settings

Studies and newspaper headlines have focused mainly on medical errors in hospitals, while safety in ambulatory settings has largely been ignored, even though outpatient settings may pose the greater challenge. For instance, the number of health care interactions is far greater in outpatient settings than in hospital settings, accounting for more than 922 million physician office visits in the US in 2013, with 53% of those being primary care visits, according to data from the Centers for Disease Control and Prevention (CDC). Compare this to the 33 million admissions to community hospitals in 2014, and you can see the potential scope of the problem.

This high volume of outpatient care translates into greater potential for medical errors, with not only major human costs, but also serious financial consequences: from 2005 to 2009, some 11,000 malpractice claims were paid on behalf of physicians, including 43% for events in outpatient settings, according to a 2011 study in JAMA. Many of these errors had very severe consequences, with 36% involving major injury and close to 31% of them ending in death.

Now the American College of Physicians (ACP) has issued a policy paper aimed at improving patient safety in office-based practices.

“In recent years, much attention has been focused on improving patient safety in hospitals,” said ACP president Jack Ende, MD, MACP. “We now must extend that focus to include the ambulatory setting. Medical errors that happen outside of the hospital are just as important to prevent.”

The ACP position paper outlines seven key recommendations for physicians and health care organizations:

  • Promote a culture of patient safety within office practices and among colleagues
  • Conduct research to address physician stress, burnout, and other factors that may impact medical errors
  • Educate patients and family in a way that reflects a diverse and inclusive range of linguistic and cultural characteristics
  • Support research and development towards standardized patient safety metrics and strategies
  • Encourage team-based care models to improve safety and facilitate communication, cooperation, and information sharing
  • Tailor health information technology systems to emphasize patient safety improvement
  • Support a national effort to prevent patient harm across the health care sector

“Physicians and other members of the health care team, including patients and their families, must work together to create an environment where safety can be discussed in an open and respectful manner,” Dr. Ende said.

Click here to download the full policy paper.

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