When the Institute of Medicine’s 1999 “To Err is Human” report on medical errors came out, public health advocates clamored for change within the hospital setting. This was a good first step. However, it’s not the last step in securing patient safety. Far more patients are seen in ambulatory care settings such as clinics, doctors’ offices, and skilled nursing facilities. It’s estimated that these facilities see more than 300 times the number of patients than hospitals admit. Yet, the patient safety focus has inexplicably not touched on these areas of patient care.
Research has shown that as many if not more mistakes occur in these facilities than in hospital settings. It’s a dangerous assumption that the more egregious medical errors occur in hospitals. In fact, a missed diagnosis, prescription dosage error, or a failure to provide follow-up care can cause as much harm as a wrong-site surgery in a hospital.
We need to make our approach to patient safety holistic. If the majority of patient care takes place in non-hospital settings, we should focus patient safety efforts on these settings as well as the hospitals.
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