Although most would agree with this axiom, the historical focus on safety programming and research initiatives has really centered on hospital stays. Yet, the ambulatory setting is also rife with potential safety pitfalls.

 

In recognition of the increasing volume and complexity of procedures undertaken in outpatient settings, the Medical Group Management Association (MGMA) recently released a white paper on the subject – "Meeting the Challenge of Patient Safety in the Ambulatory Care Setting."

 

The logistics involved in outpatient care requires having systems in place to keep important information from falling through the cracks. Not only must onsite clinicians and administrators work together effectively but communication must be coordinated across numerous sites including ancillary service providers facilities and specialty practices and with a variety of audiences including the patient, caregivers, and other providers.

 

"Safety is really a point where the business and clinical intersect," said MGMA President and CEO William Jessee, MD, FACMPE. "So many of the areas of patient safety problems, particularly in the ambulatory setting, are not really (about) physicians not doing the right thing clinically." Instead, he said, it's typically a procedural or systems issue that can often be addressed relatively easily by bringing the problem to light.

 

One example that crops up again and again is not properly communicating lab results. Is there a tracking system to ensure a lab report actually gets back to the primary care setting? If the report did arrive in a timely manner, were the results communicated with the physician? Did the physician follow up with the patient? "Those are all administrative issues, and they have a lot of impact on patient safety," Jessee pointed out.

 

To effectively address the safety issue, providers and administrators must agree to make it a priority. "Try to establish the culture in the organization that nothing is more important than your patients being safe when they are in your custody," Jessee said. However, he continued, it's nearly impossible to enact change without first assessing the current system. "You can't begin to improve things until you know where you stand."

 

To assist organizations in this quest, MGMA has created the Physician Practice Patient Safety Assessment (PPPSA), which is a free tool available to all. The self-assessment encourages practices to focus on their policies and procedures for medication safety, patient handoffs and transitions, surgery and invasive procedures, personnel qualifications and competency, practice management and culture, and patient education and communication. Jessee noted that many of the physicians and administrators who led their practice through the PPPSA were "a) surprised and b) distressed!"

 

He added, "Ambulatory care is really a place where there's a lot of hand-offs, and anytime there is a hand-off, you risk a fumble."

 

Many patient safety issues could be addressed by implementing checks and balances. Relatively simple tracking systems have the ability to flag missed communications or a ball that's been dropped. 

 

"Certainly, it's easier with technology, but there's no reason that kind of follow up can't be done with a manual system," Jessee said, adding that cost shouldn't be a barrier to implementing effective safety practices.

 

He also urged ambulatory providers to take the long view on any costs incurred in improving systems. "Safety is directly related to reducing your liability risk," he pointed out, adding the cost and toll of a lawsuit would typically far outweigh the investment and manpower to upgrade systems.

 

Jessee also said an emphasis on safety could actually be a revenue generator. He lamented the fact that veterinarians and dentists do a much better job of sending out postcard reminders about preventive and routine care than most medical practices. After all, Jessee noted, preventing illness on the front end is the ultimate safety measure.

 

"It's fairly easy to set up those types of tickler systems," he said. "They generate income for the practice, bring patients back in for services, and they also create customer loyalty."

 

Jessee added one of the challenges facing medical organizations today is finding a way to be more effective in managing patients without taking up additional staff time. One potential solution is utilizing a Web presence to underscore patient safety messages.

 

"There have been many studies showing what patients are told in their doctor's office goes in one ear and largely out the other," pointed out Jessee. "It's a high anxiety situation for patients, and they don't retain what they are told." However, he continued, online patient education tools offer a means to reinforce messages and interact with patients.

 

Ultimately, Jessee said it takes a multi-disciplinary team to assess current practices and craft new policies. Like most journeys, the process begins with a single step. Through numerous online resources and tools, MGMA is encouraging administrators to take the lead on safety issues in the ambulatory setting.