Medical Errors in Outpatient Settings

There’s been quite a bit in the news lately about medical errors in hospitals. And hospitals are making concerted efforts to reduce errors (although there is still much room for improvement). But you don’t often hear about the dangers patients face in doctor offices, urgent care centers, day surgical centers and even their homes. Do you know what can kind of mistakes doctors make that can impact your health? Do you know how to reduce your risk of medical errors in outpatient settings?

Doctors see more patients in offices than hospitals.

Patients see doctors in outpatient settings much more often than in hospitals. In fact, each year there are 950 million doctor office visits in the US, in contrast to 34 million hospital discharges. Note these statistics don’t include federal government run hospitals, like VA hospitals.

How are patient safety and medical errors related?

Simply put, a medical error is a mistake made by a health professional which can result in patient harm. More precisely, a medical error is when an action (or task) is not completed as intended, or when the wrong action/task is used. There are countless places where errors may occur, including problems in practice, products, procedures, and systems.

Patient safety efforts address how hospitals and other health care organizations protect their patients from errors, injuries, accidents, and infections.

What kinds of medical errors in outpatient settings should you worry about?

Errors in outpatient settings generally fall into one of these 3 categories:

• Diagnostic – such as an error or delay in diagnosis
• Treatment – error in an operation, procedure, medication or test
• Preventive – inadequate monitoring or follow-up of treatment

What about errors in primary care?

Primary care doctors report errors that involve complications from misdiagnosis, poor communication and medication issues. Additionally, errors can occur due to broader organizational or system issues.

How common are errors in outpatient settings? 

Unfortunately, errors made in outpatient settings are considered to be as common, if not more prevalent, than errors made in hospital settings. Yet it’s hard to find data on the numbers of these errors.

However, a 2020 report by the Foundation for the Innovation and Development of Health Safety estimates that as many as 4 in 10 patients are harmed in primary and outpatient healthcare settings across the globe, in developing and developed nations. Furthermore, the report states that up to 80% of these medical errors are preventable.

How serious are errors in outpatient settings?

There is no doubt about it, these errors can lead to serious harm and even death. But data on the frequency and severity of harm are not readily available.

However, one way to evaluate the seriousness of medical errors is to look at successful medical malpractice claims. A review of medical malpractice claims (2005 to 2009) found:

• 43% of the 10,739 claims paid on behalf of doctors were for incidents in outpatient settings.
• Of the claims for outpatient settings, 46% were for diagnostic errors.

Sadly, the outcomes were often tragic:

• 36% led to major injury.
• Nearly 31% of events led to the patient’s death.

Of course, people often don’t report errors. And many medical errors don’t involve malpractice claims. Therefore, the data from malpractice claims only represent a portion of medical errors made, and likely represent only the most serious of errors. Scary, right? Therefore, we should all care about this!

Why hasn’t patient safety improved in outpatient settings?

According to a report by the American College of Physicians, reducing errors in outpatient settings is complicated. Why? Because there are thousands of outpatient care providers in the US, many of whom don’t have the time or resources for patient safety efforts.

Furthermore, the government’s efforts on patient safety usually focus on hospital issues; efforts which are generally not relevant to outpatient care. Yet there is some good news. Private and government agencies are paying more attention to reducing safety issues in outpatient settings.

How can doctors and health care organizations improve safety in outpatient settings?

In 2017, the American College of Physicians released a policy paper with recommendations for doctors and organizations to improve safety. While improving safety will require a lot of effort and real changes, the benefits are worthwhile.

The report includes the following suggestions for doctors and healthcare organizations:

• Promote a culture of patient safety by:
  • making safety a part of every employees’ job
  • not penalizing employees who report errors
  • encouraging accurate, confidential reporting of events and near-misses
  • working with patients to address safety issues
• Increase projects to identify and address doctor stress, burnout, and work culture issues that may impact medical errors.
• Improve patient and family education, engagement, and health literacy efforts to educate the public about asking the right questions. Provide patients and families with easily understood medical information.
• Adopt team-based care models, such as the patient-centered medical home, to improve patient safety and facilitate communication, cooperation, and information sharing among providers.
• Tailor health information technology systems to emphasize patient safety improvements.
• Establish a national effort to prevent patient harm in outpatient settings.

How can your reduce your risk of medical errors in outpatient settings?

Since your health can depend on how you manage your care, I suggest the following:

• Prepare for appointments by writing down your “story” and your questions ahead of time.
• Be sure your doctor hears your whole story – don’t let interruptions dissuade you.
• It’s important you understand what the doctor is saying, so ask the doctor to repeat any information you don’t understand.
• For further clarification, ask for written materials, including diagrams and illustrations as needed.
• Make sure you understood the doctor correctly by repeating what you heard for confirmation.
• Make sure each doctor on your team has a complete list of all medications you are taking, including over-the-counter drugs.
• If a diagnosis doesn’t make sense, share your concerns with your doctor. Ask if your story “fits” with the diagnosis, and if not, ask for an explanation of the symptoms that don’t “fit” the diagnosis.
• Get a 2nd opinion, or even a 3rd opinion, preferably from a doctor at a different practice/hospital. When speaking with a new doctor, be sure to tell the doctor your story. Don’t let him/her rely on notes from other doctors.
• If something doesn’t seem right, speak up!

For more tips, read these blog posts:

• 10 Tips to Communicate Better with Doctors.
• How Can You Get the Best Healthcare? Actively Participate!
• The Importance of Shared Decision Making.
• The Dangers of Too Many Medical Tests and Treatments.
• Why are Second Opinions Important?
• 10 Tips for a Better Medical Appointment.
• Should You Record Medical Appointments?