If it could be said that the Age of Hospital Quality dawned with the 1999 Institute of Medicine's seminal report, "To Err Is Human," then the Age of Outpatient Quality may finally be dawning now.
I've counted eight reasons why the safety movement is rapidly accelerating in the ambulatory care arena, inspired by one major reason: the American Medical Association devoted a 194-page report to the topic just before the holidays.
The group's review lists the stumbling blocks as well as the possibilities of improvement through better research, better definitions of what constitutes poor quality, and improved measurement tools for community clinics, office practices, and surgical centers.
"I think there's definitely momentum now," says Matt Wynia, MD, an internist at the AMA's Institute for Ethics and the Center for Patient Safety, the report's lead author. "The number one thing I keep repeating is that there are 300 patients seen in ambulatory settings for every one person admitted to a hospital, and [there are] a hugely disproportionate number of encounters that take place in ambulatory settings."
Of course, one wonders why it's taken 12 years for quality leaders to focus on outpatient errors, and there are just about that many long-winded and complex explanations. For starters, there's no infrastructure to lead the way as there is in acute care facilities, with chief quality and compliance officers to make sure rules exist and are followed.
Nevertheless, the period that Wynia and co-author David Classen, MD, called in a recent journal commentary "the lost decade in ambulatory safety" is about to find its way.