Medical errors became a popular issue when the 1999 Institute of Medicine (IOM) report To Err is Human: Building a Safer Health System (1) cited it as cause for concern. The focus was on hospital-related errors because that is where they were well documented. Who knew that, due to the trend of increasing outpatient-care delivery and increasing patient loads, medical office errors might be responsible for the majority of medical errors?

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According to the Agency for Healthcare Research and Quality, “Errors occur not only in hospitals but in other health care settings, such as physicians’ offices, nursing homes, pharmacies, urgent care centers, and care delivered in the home.” Nearly two-thirds of all surgical procedures are performed in the outpatient setting. (2) The IOM report estimates the cost of medical errors to be $37.6 billion each year, and about half of this is attributed to preventable errors.

Types of problems. The IOM defines medical errors as “the failure to complete a planned action as intended or the use of a wrong plan to achieve an aim.” Adverse events are defined as “an injury caused by medical management rather than by the underlying disease or condition of the patient.”

• Failure to diagnose, e.g., cancer, myocardial infarctions, infections and fractures (3). Failure to diagnose can fall into two categories, those of commission, and omission (“Inadequate care for people with chronic illnesses was particularly common.”)(4)
• Medication errors and adverse drug reactions
• Abnormal test results, e.g., blood tests, imaging studies, Pap smears, procedural tests; tests that are incomplete, late, lost, wrong test performed, filing mistakes and/or lack of follow-up
• No-shows and lack of follow-up when rescheduling is required
• Referrals and lack of follow-up with consultant
• Patient education (treatment, medication, informed consent)
• Vaccines and maintenance procedures, e.g., breast and colon-rectal cancer screenings and pneumonia prevention. (3)

Error prevention. As varied as the above errors are, system errors and “the potential for relatively frequent systematic errors” (5) are cited as common reasons for medical errors.

Examples of how to improve an office system would be to combine reminder phone calls or mailings (to avoid no-shows) with a reminder to bring medication bottles or updated medication lists of all physicians the patient sees, use of information technology and standardized treatment policies and protocols. 

References

1. Kohn LT, Corrigan JM, Donaldson MS, editors. To err is human: building a safer health system. A report of the Committee on Quality of Heath Care in America. Institute of Medicine. Washington, DC: National Academy Press; 2000.
2. Society for Ambulatory Anesthesia, “Patient Information”, (30 November 2001)
3. ACP-ASIM Observer, June 2002. Strategies to tackle outpatient errors
4. Hayward, R., Sins of Omission. Getting Too Little Medical Care May be the Greatest Threat to Patient Safety. J Gen Intern Med 2005; 20:686-691
5. Phillips, RL. Learning from malpractice claims about negligent, adverse events in primary care in the United States. Qual Saf Health Care 2004; 13:121-126.

About the Author

Dr. Flippin brings a wealth of experience, starting with her long tenure as an attending physician at the Cook County Hospital Emergency Department. She is currently Corporate Compliance and HIPAA Privacy Officer at major Chicago hospital.

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