ECRI Institute PSO Deep Dive: Safe Ambulatory Care

Strategies for Patient Safety & Risk Reduction

Overview

For its eighth deep dive analysis, ECRI Institute PSO has extended the focus beyond the hospital to ambulatory care—a setting that represents the largest and most widely used segment of the healthcare system. Ambulatory care settings provide a diverse array of services to patients, from consultation and diagnosis to treatment and intervention.

In recent years, many ambulatory care practices have evolved from being largely independent operations to becoming part of accountable care organizations (ACOs) or entering into affiliations with—or becoming owned by—local regional hospitals or larger health systems. Processes and policies between and among organizations can be disjointed, making care coordination difficult at times; for example, consultation reports may not be available to primary care physicians, or centers within the same healthcare organization may have different record-keeping systems. Whether a care setting is part of an ACO, is affiliated with or owned by a larger system, or operates independently, all staff must possess or develop skills to strengthen teamwork, communication, and collaboration. Training, support, and organizational culture must echo these goals, just as they must in a hospital environment.

As more healthcare encounters and procedures shift from hospitals to smaller, less expensive ambulatory settings, such as physician practices and community health centers, as part of achieving the Institute for Healthcare Improvement’s (IHI) Triple Aim Initiative—better care for individuals, better health for populations, and lower per capita costs—a health system’s patient safety efforts must reach and embrace these settings of care. Challenges in this endeavor include the following:

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