Maria Castellucci October
23, 2019 04:55 PM
Diagnostic errors are the most
frequent adverse safety event patients can experience in outpatient care,
according to a new ECRI Institute report.
The analysis, published Wednesday,
found that diagnostic testing errors represented 47% of all patient safety
events reported in an outpatient setting over a one-year period. The second-most
common safety event was medication errors, accounting for 27% of total events.
Considering the volume of testing
performed in the ambulatory setting and the complexity of the process, it's not
surprising it's the most common mistake that happens in outpatient care, said
Carol Clark, acting associate director of the ECRI Institute Patient Safety
Organization.
Diagnostic testing has many phases
including ordering the appropriate test, gathering and delivering the sample
appropriately and interpreting the results. Additionally, about 40% of all
primary-care office visits involve some medical test.
"There's a lot of opportunity
for errors," Clark said.
The report says 4,355 adverse
events were voluntarily reported from December 2017 to November 2018. Providers
submit adverse events to the ECRI Institute as part of their participation in
its patient safety organization. More than 1,800 providers are part of the
organization and 3 million adverse events overall have been reported.
The report included data from
ambulatory care centers, community health centers and physician practices.
Ambulatory surgery centers were excluded from the analysis because they don't
provide comparable services.
In its report, ECRI recommended providers
establish a chain of command for communicating test results and use technology
to track test results and ensure follow-up, among other practices that could
prevent diagnostic errors.
Even with the recommendations,
Clark said there is "no magic bullet" to preventing diagnostic
errors. Solutions are likely unique to the practice and their resources.
There is more momentum recently to
address diagnostic errors. The Society to Improve Diagnosis in Medicine has
gathered stakeholders from across the country to enhance research and encourage
greater attention from providers on the problem.
Society CEO Paul Epner said
previous studies correlate with ECRI's findings that diagnostic mistakes are
the most common medical errors in healthcare. Although he added that ambulatory
settings have more complexities to deal with than acute settings, making the
errors particularly challenging to prevent. Usually outpatient settings don't
have labs in-house so they have to send off their samples, leaving room for
samples to be mishandled or results to never get back to the doctor.
In terms of medication errors, most
were caused by giving the patient the wrong drug, the report found.
Clark said this can occur because
centers haven't implemented processes to ensure the right medications go to the
correct patient. It can be an issue of how the medications are stored or the
training of the personnel who distribute it. Medical assistants typically
administer medications now rather than nurses and sometimes they aren't
appropriately trained, she said.
The second-most common reason for a
medication error involves ordering or administering treatments that trigger
allergies or adverse reactions. It's particularly hard to prevent those errors
in outpatient care because they typically don't have a complete medical history
of the patient, Clark said. Incompatible electronic health records usually mean
outpatient providers aren't aware of all medicines a patient is on.
Reconciliation and thorough patient assessments are vital to prevent medication
errors, Clark said.
Falls were the third most frequent
adverse event reported during the period, accounting for 14% of total events.
Falls are likely common because
most patients who see their physician frequently are elderly or have
comorbidities, which can make them weak, frail or disoriented, Clark said.
One way to prevent falls is to
screen the patient for fall risk during the initial assessment, according to
the report.
Although it only represented 5% of
the total events, security issues were addressed in the report.
Workplace violence is a well-known
problem in healthcare, and clinicians who work in ambulatory care are
particularly vulnerable because they lack the security and robust personnel
that acute-care settings have, Clark said. She expects incidents are
significantly underreported because many clinicians are so used to the conditions,
but it can impact quality of care and contribute to burnout.
The report recommends doing risk
assessments to evaluate potential opportunities for violence, provide staff
with tools to recognize cues for combative behavior and train staff on how to deal
with aggressive situations.
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