Ambulatory care: The next frontier in patient safety

While acute-care hospitals across the country work diligently to improve care and reduce adverse events, what about the outpatient setting? What happens to the patient who is transitioned from one setting to another and has multiple chronic conditions? Is the patient and his or her family engaged in decision-making? Is there coordination among primary care providers and specialists? Is there discharge planning so that the patient can better self-manage illness and recovery? 

The Health Research & Educational Trust (HRET) was recently awarded a contract from the Agency for Healthcare Research and Quality (AHRQ) to work with experts in ambulatory care, patient and family engagement (PFE) and care transitions to create a toolkit specific to the ambulatory care setting. By improving communication among patients and families and clinical staff during ambulatory transitions in care, the toolkit has the potential to address any safety issues that may arise. A growing body of evidence shows a clear association between engaging with patients and families, fewer adverse events, better patient self-management and reduced hospital readmissions. 

Using AHRQ’s Guide to Patient and Family Engagement in Hospital Quality and Safety as a model, the HRET team developed a toolkit to help ensure smooth ambulatory transitions in care. Two locations will pilot the toolkit: Vidant Health Belhaven and University of Washington’s General Internal Medicine Clinic. Joan Wynn, chief quality officer of Vidant Health, tells me that she is excited to work on tools to improve communication and transitions of care from one provider to the next. In addition, Farrah Leland with the University of Washington says that the ambulatory care toolkit will be instrumental in enabling us to empower patients to take ownership and leadership in their care. 

This project aligns well with HRET’s increased focus on promoting Patient and Family Engagement (PFE) to prevent patient safety issues. With additional funding from the Gordon and Betty Moore Foundation, HRET surveyed hospitals across the U.S. about their PFE strategies. In addition, HRET’s Hospital Improvement & Innovation Network will expand on the PFE work of its Hospital Engagement Network 2.0, adding a special fellowship for those who are working on this topic at their hospitals.

The project also builds on HRET’s work in ambulatory care. HRET worked on an AHRQ-funded project to improve patient safety in ambulatory surgery centers, including a toolkit set to be released in 2017. Further, HRET continues to work with AHRQ to improve communication and teamwork skills among providers through the AHRQ-funded, in-person TeamSTEPPS for Office-Based Carecourses that are now being expanded to offer content online.

With evidence demonstrating a strong connection between PFE and safer care, and with many resources focused on engaging patients and their families to improve care, now is the time to reduce errors and improve quality in the outpatient setting. If health care leaders across the continuum are truly committed to enhancing safety, then PFE must become hardwired into their practices. The next health care frontier will have the patient firmly rooted at the center of the care team, improving both experience of care, as well as connecting patient insights to reduce diagnostic errors. Who is on board? 

Katie Johnson, program manager, HRET, contributed to this post.