How to Promote Patient Safety in the Outpatient Setting

Healthcare organizations often focus their patient safety efforts on the inpatient setting, but research shows a significant number of patients experience adverse events in the outpatient setting.

The primary patient safety risks in the outpatient setting include data overload, medication interactions, and communication breakdowns with patients, according to the assistant CMO of a federally qualified health center in Indiana.

In healthcare, the focus of patient safety efforts is often on the inpatient setting such as hospital-acquired conditions and falls. However, a study published in The Annals of Internal Medicine found that 7% of patients experienced at least one adverse event and 1.9% of patients experienced at least one preventable adverse event in outpatient settings.

Michael Kozak, MD, MPA, assistant CMO at Valparaiso, Indiana-based HealthLinc, says data overload is top patient safety concern in the outpatient setting.

"There is a wealth of data available on patients, but something can fall through the cracks," Kozak says.

Data overload is also an issue from a medical-legal standpoint, according to Kozak.

"The data could indicate that you were supposed to do something in a defined amount of time, but it wasn't done," Kozak says. "There may have been data identifying a disease state that made your decision the wrong one."

There are two main approaches to addressing data overload in the outpatient setting, according to Kozak.

"There is a saying in medicine that dealing with data is like drinking from a fire hose. The whole notion of that saying is that drinking from a fire hose is impossible," Kozak says. "We must figure out what to ignore and focus on themes that we can learn from."

The second approach to addressing data overload in the outpatient setting is managing data from patient testing. The data from tests is in the electronic medical record, Kozak explains, but the ability to bring that data together is more limited than it should be.

"We can use technology to put this data together, summarize data, and use clinical decision support," Kozak says. "If you can use clinical decision support to provide you with updated answers, it can be immensely helpful."

Medication interactions are a serious patient safety concern in the outpatient setting, according to Kozak.

There is technology available to avoid adverse medication interactions in the outpatient setting, but technological solutions come with challenges, Kozak explains, one of which is alert fatigue.

"There can be minor medication interactions, and alerts for them can pop up in the electronic medical record," Kozak says. "The problem is that you can get alerts for everything, but once you are alerted to everything, you can become overwhelmed and alerted to nothing."

Communication breakdowns with patients also pose patient safety risks in the outpatient setting, according to Kozak.

"For example, a clinician may be behind in their documentation and focused on a CT scan that is needed, then fail to hear something from the patient that was very important," Kozak says. "Not hearing the patient is an obvious safety risk."

Ambient listening AI tools can help clinicians improve communication with patients, Kozak explains.

"These tools give the clinician a better ability to listen to the patient," Kozak says. "With ambient listening AI tools, clinicians have a better ability to bond with the patient and understand their priorities."

HealthLinc uses Greenway Clinical Assist powered by Nabla as its ambient listening AI tool.

As a practicing clinician, Kozak says the ambient listening tool helps him flag items in the summary of a patient visit that he would have either neglected to document or hadn't queued up as an order.

"For instance, I may have mentioned an X-ray of a finger to a patient during an encounter," Kozak says. "It was an incidental component of the deeper conversation about a patient's heart failure, but it mattered nonetheless. While that may have slipped my mind to put the order in as larger items were being discussed, the ambient listening caught it and helped me to provide the care that was discussed."

Michael Kozak, MD, MPA, is assistant CMO at HealthLinc, a federally qualified health center based in Valparaiso, Indiana. Photo courtesy of HealthLinc.

Responding to Adverse Events in the Outpatient Setting

When an adverse event occurs in the outpatient setting, a healthcare organization must be made aware and determine the root cause, according to Kozak.

"If an easy course of action leads to an adverse event, then you need to insert a little bit of friction to avoid the easy course of action being the default position," Kozak says. "If the right thing to do requires a hard course of action, you need to reduce the friction to make the right thing to do easier."

To identify the root cause of an adverse event in the outpatient setting, CMOs and other clinical leaders need to look at the documentation of care and talk with any staff members who were involved in the adverse event, Kozak explains.

"When you talk with people about an adverse event, you need to not only ask why the event occurred, but also why an incorrect choice of action was taken," Kozak says. "You need to ask what was going through a person's mind and ask what didn't stop them from contributing to an adverse event."

Examining the processes involved in an adverse event is essential, according to Kozak.

"We need to look at whether we are setting our staff members up for success or whether we are crossing our fingers and hoping staff members follow the right path," Kozak says. "The best care should be facilitated rather than the hard thing to do."