Adverse events in the outpatient setting

May 28, 2024

Source: Levine, et al Annals of Internal Medicine, May, 2024 LINK  These numbers are based on structured chart reviews electronic medical records.

We’ve known about the uncomfortably common and medically devastating impact of medical errors in hospital settings since the Institute of Medicine published “To Err is Human” in 1999. But medical errors outside of the hospital are less likely to be reported.

Researchers in Annals of Internal Medicine demonstrated that there are far too many adverse safety events on an outpatient basis, too. In this study, nurses performed a standardized review of over 3,100 complete electronic medical records at 11 outpatient centers in Massachusetts during 2018. (This might seem a long time ago, but studies like this are enormously time-consuming.) They found that about 7% of those patients had an adverse event, although only a minority of these were preventable. Most adverse events were adverse drug events (64%), infections (15%) and surgical or procedural complications (14%). One in seven (17.4%) of the adverse effects were serious and one in 50 (2.1%) were life-threatening. Some complications of outpatient medical care might not have been revealed in medical record review, and many of the complications (like falls or pressure sores) might not be due to defects in the medical care provided.

Implications for employers:

• Employers should be reassured that most adverse events (over three-quarters) were not deemed preventable.

• Employers can ask their carriers what efforts they are making to identify quality and safety problems among their providers and steer plan members to both outpatient and inpatient providers with the best safety profiles.

Thanks for reading.  You can find previous posts in the Employer Coverage archive

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