The Safety of Outpatient Health Care: Review of Electronic Health Records
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Visual Abstract. The Safety of Outpatient Health Care
The harms that occur to patients in the hospital are relatively well documented. In contrast, less information is available about the harms that occur to outpatients, even though the amount of health care being delivered in outpatient settings and the complexity of that care are increasing. This article describes the frequency and types of harm that occurred at 11 outpatient sites in Massachusetts during 1 year.
Abstract
Background:
Despite considerable emphasis on delivering safe care, substantial patient harm occurs. Although most care occurs in the outpatient setting, knowledge of outpatient adverse events (AEs) remains limited.
Objective:
To measure AEs in the outpatient setting.
Design:
Retrospective review of the electronic health record (EHR).
Setting:
11 outpatient sites in Massachusetts in 2018.
Patients:
3103 patients who received outpatient care.
Measurements:
Using a trigger method, nurse reviewers identified possible AEs and physicians adjudicated them, ranked severity, and assessed preventability. Generalized estimating equations were used to assess the association of having at least 1 AE with age, sex, race, and primary insurance. Variation in AE rates was analyzed across sites.
Results:
The 3103 patients (mean age, 52 years) were more often female (59.8%), White (75.1%), English speakers (90.8%), and privately insured (70.4%) and had a mean of 4 outpatient encounters in 2018. Overall, 7.0% (95% CI, 4.6% to 9.3%) of patients had at least 1 AE (8.6 events per 100 patients annually). Adverse drug events were the most common AE (63.8%), followed by health care–associated infections (14.8%) and surgical or procedural events (14.2%). Severity was serious in 17.4% of AEs, life-threatening in 2.1%, and never fatal. Overall, 23.2% of AEs were preventable. Having at least 1 AE was less often associated with ages 18 to 44 years than with ages 65 to 84 years (standardized risk difference, −0.05 [CI, −0.09 to −0.02]) and more often associated with Black race than with Asian race (standardized risk difference, 0.09 [CI, 0.01 to 0.17]). Across study sites, 1.8% to 23.6% of patients had at least 1 AE and clinical category of AEs varied substantially.
Limitation:
Retrospective EHR review may miss AEs.
Conclusion:
Outpatient harm was relatively common and often serious. Adverse drug events were most frequent. Rates were higher among older adults. Interventions to curtail outpatient harm are urgently needed.
Primary Funding Source:
Controlled Risk Insurance Company and the Risk Management Foundation of the Harvard Medical Institutions.
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Published In
Annals of Internal Medicine
Volume 177 • Number 6 • June 2024
Pages: 738 - 748
History
Published online: 7 May 2024
Published in issue: June 2024
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© 2024 American College of Physicians.
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The Safety of Outpatient Health Care: Review of Electronic Health Records. Ann Intern Med.2024;177:738-748. [Epub 7 May 2024]. doi:10.7326/M23-2063
The Safety of Outpatient Health Care: Review of Electronic Health Records. Ann Intern Med.2024;177:738-748. [Epub 7 May 2024]. doi:10.7326/M23-2063
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