title: Patient safety in the ambulatory setting. A clinician-based approach.
abstract: BACKGROUND
  Voluntary reporting of near misses/adverse events is an important but underutilized source of information on errors in medicine. To date, there is very little information on errors in the ambulatory setting and physicians have not traditionally participated actively in their reporting or analysis.
  
  
  OBJECTIVE
  To determine the feasibility and effectiveness of clinician-based near miss/adverse event voluntary reporting coupled with systems analysis and redesign as a model for continuous quality improvement in the ambulatory setting.
  
  
  METHODS
  We report the initial 1-year experience of voluntary reporting by clinicians in the ambulatory setting, coupled with root cause analysis and system redesign by a patient safety committee made up of clinicians from the practice.
  
  
  METHODS
  Internal medicine practice site of a large teaching hospital with 25,000 visits per year.
  
  
  RESULTS
  There were 100 reports in the 1-year period, increased from 5 in the previous year. Faculty physicians reported 44% of the events versus 22% by residents, 31% by nurses, and 3% by managers. Eighty-three percent were near misses and 17% were adverse events. Errors involved medication (47%), lab or x-rays (22%), office administration (21%), and communication (10%) processes. Seventy-two interventions were recommended with 75% implemented during the study period.
  
  
  CONCLUSIONS
  This model of clinician-based voluntary reporting, systems analysis, and redesign was effective in increasing error reporting, particularly among physicians, and in promoting system changes to improve care and prevent errors. This process can be a powerful tool for incorporating error reporting and analysis into the culture of medicine.
authors.affiliation: University of Virginia Health Systems, Charlottesville, VA 22908, USA. mp5k@virginia.edu
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Plews-Ogan
authors.forename: Mohan M
authors.initials: MM
authors.lastname: Nadkarni
authors.forename: Sue
authors.initials: S
authors.lastname: Forren
authors.forename: Darlene
authors.initials: D
authors.lastname: Leon
authors.forename: Donna
authors.initials: D
authors.lastname: White
authors.forename: Don
authors.initials: D
authors.lastname: Marineau
authors.forename: John B
authors.initials: JB
authors.lastname: Schorling
authors.forename: Joel M
authors.initials: JM
authors.lastname: Schectman
mesh_terms: D016907:Adverse Drug Reaction Reporting Systems; D000553:Ambulatory Care / Q000592:standards*; D005180:Faculty, Medical; D005240:Feasibility Studies; D006784:Hospitals, Teaching; D006801:Humans; D007388:Internal Medicine / Q000592:standards*; D019300:Medical Errors / Q000517:prevention & control*; D010044:Outpatient Clinics, Hospital / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000379:methods; D017751:Safety Management; D013597:Systems Analysis; D035141:Voluntary Programs