Medical Errors Outside the Hospital

Laura Landro of The Wall Street Journal Health Blog has published an interesting article concerning medical errors that occur in places outside the hospital setting. Examples include doctors’ offices, outpatient surgery clinics, and other medical clinics. The WSJ Health Blog concludes that attempts to improve patient safety should move beyond the hospital setting to outpatient settings.

Laura Landro cites a new study published in the Journal of the American Medical Association that analyzes malpractice claims paid on behalf of physicians. According to the AMA’s study, 10,739 medical malpractice claims were paid in 2009. In that year, the number of outpatient and inpatient claims was approximately the same.  However, the proportion of claims associated with outpatient care had slightly increased.  Counting events involving both settings, 52.5% involved outpatient care at least in part, resulting in about $1.5 billion in malpractice payments according to Laura Lando’s blog article. (Presuming that medical malpractice claims represent only a small proportion of adverse events or mistakes, malpractice claims are one of the ways to analyze medical errors.)

The lead author of the AMA study was Tara Bishop who is an assistant professor of public health at Weill Cornell Medical College. Dr. Bishop told the WSJ Health Blog that although there are about 30 times more outpatient visits as inpatient visits per year, the characteristics of the two visits are so different that it’s very difficult to make a direct comparison about the relative risk of an error.

Nonetheless, Dr. Bishop told the WSJ Health Blog that the sheer number of outpatient-related medical malpractice claims was surprising, and suggests that this area needs attention.  According to Dr. Bishop and her colleagues, the proposition is complicated because “there are many more sites of outpatient care than inpatient care, and many outpatient sites may be too small to have well-trained staff who devote significant attention to improving patient safety.”

Almost 50% of the outpatient medical malpractice claims were associated with diagnosis, according to the WSJ Blog, which cites Tejal Gandhi, chief quality and safety officer at Partners Healthcare. Gandhi was co-author of a Perspective piece on outpatient-care related errors published in the fall of 2010 by the New England Journal of Medicine.  Gandhi concurs that diagnostic mistakes are a major source of problems. Gandhi states that her own research suggests diagnostic errors are not the result of a single mistake, but of a series of mistakes in the process – for example, failing to order or follow up on a test combined with a lapse or memory.

The WSJ Health Blog quotes Gandhi as saying “For every missed or late diagnosis, an average of three things went wrong.” According to Gandhi, it is easier – though not necessarily easy – to develop systems to improve test-result management instead of trying to handle medical mistakes that arise from poor judgment or memory lapses says.

Gandhi stated that medication errors, which are also common in outpatient settings, can potentially be avoided with the use of e-prescribing and electronic-medical record systems. However, according to the WSJ Health Blog, Gandhi cautions that the systems must be implemented well and that there are still many questions concerning how to best maintain accurate medication lists.

Another big source of medical errors involving outpatient care is the transition from the hospital to community-cased care.  Laura Landro quotes Gandhi as saying “We need better partnerships between in- and outpatient settings,” including communication and data flow between institutions. Gandhi states “We need hospitals and primary-care providers and specialists to work together on this,” according to Laura Landro.  Gandhi further says that efforts must include rehabilitation and skilled-nursing facilities in addition to doctors’ offices.

The WSJ Health Blog cites the National Quality Forum, a government-advisory group that develops voluntary safety standards, which announced its latest list of serious reportable events – largely preventable medical errors such as wrong-site surgery and medication errors.  For the first time, the events have been analyzed for their applicability to the office-based practices, ambulatory surgery centers and skilled nursing facilities in addition to hospitals.

With the number of outpatient medical malpractice cases on the rise, Boyd B. Newton PC, an Atlanta Medical Malpractice Attorney, can provide a free consultation to determine if you have a case.  You may also visit http://www.injurylawyerofatlanta.com.

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