Is Ambulatory Patient Safety Just Like Hospital Safety, Only without the “Stat”? Robert M. Wachter, MD, Annals of Internal Medicine 3 October 2006, 145:7, 547-549
The primary theme of this editorial is the fundamental difference between hospital and office patient care and the implications for patient safety. As the author states,
We now understand that the ambulatory environment is so different from the hospital environment that expertise in hospital care might not predict excellent outpatient care and might even create skills and instincts that are harmful in the ambulatory care environment.
In discussing the factors that vary in impact between the two environments, Dr. Wachter notes,
The second major difference is in the nature of the patient–provider relationship. Because the patient is neither passive nor captive in the office, patient adherence is far more important than in the hospital (Gandhi and colleagues found that 46% of errors involved significant patient factors, with nearly half of these reflecting nonadherence).1 In office practice, the focus of attention is the patient’s understanding of and agreement with the plan, which requires an appreciation of the patient’s health literacy and any possible language barriers. Talk about hospital patients being active participants in their own safety is often an empty promise (particularly in the case of the confused or desperately ill patient). On the other hand, involving the patient actively is sure to be a key component of ambulatory safety efforts. [emphasis mine]
Commentary
Dr. Watchter’s comments are a worthwhile reminder of the significance of patient compliance in office practice and the need for clinicians to be aware of and adapt to varying circumstances in supporting adherence and, by extension, treatment implementation.
[Photo by mstephens7 at Flickr]
Footnotes
__________- Gandhi TK, Weingart SN, Seger AC, Borus J, Burdick E, Poon EG, et al. Outpatient prescribing errors and the impact of computerized prescribing. J Gen Intern Med. 2005;20:837-41. [PMID: 16117752]↩