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A study by researchers at Mass General Brigham has revealed that patient adverse events are prevalent and persistent in outpatient settings including visits to primary care physicians, specialty care, day surgeries, and other settings.

The research analyzed patient care in 2018 at four Boston-area healthcare systems and provides insights on the most common forms of adverse healthcare events and the populations most likely to be affected. The report, published in The Annals of Internal Medicine, also suggests interventions that can improve patient safety in these care settings.

“Our study is an alarm bell,” said corresponding author David Levine, MD, of the division of general internal medicine and primary care at Brigham and Women’s Hospital. “About one-in-four people every month are touched by outpatient care, yet we do not know enough about its safety. Our study focuses on data that highlights what is a national and international issue for patients.”

While research over the past several decades has provided a wealth of information on the prevalence and types of adverse events patients can experience in the inpatient setting, few studies have focused the same attention on harms patients receive in the outpatient setting, despite the fact that it is where people receive the majority of their care.

“Healthcare organizations everywhere need to take the first step of measuring patient safety in both inpatient and outpatient settings. This work is groundbreaking, but it’s also just the beginning,” noted co-author Luke Sato, MD, of Brigham and Women’s Hospital and senior vice president and CMO at CRICO, the medical professional liability insurer for the Harvard medical community and its affiliated organizations, which also participated in the study.

For this research, the investigators conducted a retrospective review of adverse events that occurred in 2018, tapping the electronic health records (EHRs) of 3,103 randomly selected patients aged 18 and older from 11 outpatient care facilities. The data was reviewed by seven nurse reviewers who identified relevant triggers found in the EHRs. If an adverse event was suspected based on this review, the information was passed to a physician adjudicator to make the final determination if it was in fact an adverse event. Confirmed adverse events were then ranked by severity and assessed whether it was preventable using a six-point scale.

This analysis showed that 7% of patients suffered at least one adverse event in the outpatient setting and that 1.9% experienced an adverse event that was preventable. The most common adverse events were:

  • adverse drug events (63.8%)
  • healthcare-associated infections (14.8%)
  • surgical/procedural events (14.2%)
  • patient care events (8.3%)
  • perinatal/maternal events (0.7%)

Nearly half of all patient safety events occurred in a physician’s office, the most common setting for patients to receive care. For every 100 visits to the emergency department, approximately two adverse events occurred, while these events occurred in the physician’s office for about one out of every 100 ambulatory encounters.

Adverse events also disproportionately affected the elderly. Among patients over the age of 85 many had preventable (8.7%) and serious (4.4%) safety events.

“Our results call for urgent measures to curtail outpatient harm,” said Levine. “They also have the potential to help inform evidence-based interventions, pointing us to where change could be most effective to help protect patients and prevent adverse events from occurring.”

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