The majority of patients receive most of their health care in physician practice settings, in preventive care, or follow-up to inpatient stays or ambulatory procedures. Sources of variation in outpatient care settings-logistic complexity of care, increasingly complex job functions of primary care providers, increased number of patient "hand-offs," and a lack of necessary physician support systems-are often sources of increased risk to patient safety. Despite known risks, patient safety in physician practice settings has been largely unexplored until now.
HRET and partners at the Institute for Safe Medication Practices (ISMP) and the Medical Group Management Association (MGMA) Center for Research have developed several resources to help outpatient settings take steps to improving patient safety.
Pathways for Patient Safety
HRET, ISMP, and MGMA, with support from The Commonwealth Fund, have developed Pathways for Patient Safety ™, a three-part toolkit to help outpatient care settings improve safety in three areas:
Working as a Team
Assessing Where You Stand
Creating Medication Safety
The toolkit was developed with input from a panel of experts in physician practice management and patient safety. The modules provide practical tools, templates, and actionable information that require few resources to put into practice.
The Physician Practice Patient Safety Assessment
HRET, ISMP, and MGMA have also developed a self-assessment of patient safety in physician practices, through a grant from The Commonwealth Fund. The assessment helps physician practices to evaluate their processes, clarify opportunities for improvement, measure progress over time, and facilitate dialogue among staff.
The Physician Practice Patient Safety Assessment (PPPSA) is the first global, comprehensive assessment of its kind. MGMA, HRET, and ISMP developed the assessment to:
Examine the state of patient safety in outpatient settings.
Aid the development of educational resources and tools specifically
tailored to support improvement of patient safety within physician
practices.
Heighten industry awareness of distinguishing characteristics of a safe
physician practice.
Create a new baseline of practice efforts to enhance and support
patient safety.
From January to May 2006, MGMA, HRET, and ISMP gathered assessment data from a selected sample of MGMA member physician practices. There were four areas in which a relatively high percentage of practices had fully implemented safe practices:
| PPPSA ITEM |
FULLY IMPLEMENTED |
| Patients are informed of HIPAA rules and regulations. |
89%
|
| Easy access to drug information |
70%
|
| Conscious sedation with two individuals—only one monitoring. |
69%
|
| Explanation of surgical procedures performed in or outside the practice. |
67%
|
There were five areas in which a relatively high percentage of practices had little or no implementation activity:
| PPPSA ITEM |
NO ACTIVITY TO IMPLEMENT |
| Up to date written information on medication provided to non-English speaking patients. |
60%
|
| Provide emotional support for staff involved in errors. |
55%
|
| All practice staff are trained in health literacy issues. |
41%
|
| Review external error literature. |
38%
|
| Patients are routinely asked to repeat back instructions |
30%
|
The PPPSA has six domains
Medications
Handoffs and Transitions
Surgery/Anesthesia and Sedation/Invasive Procedures
Personnel/Qualifications/Competency
Practice Management/Culture
Patient Education/Communication
Use the PPPSA to:
Gain specific ideas to improve patient safety
Compare your data to aggregate results for similar practices
Enhance your team's awareness of patient safety issues
Heighten providers' awareness of characteristics that make a
practice safer
Create a new reference point and baseline to enhance and support
patient safety
Document your successes and track your progress
Any physician practice can provide safer and better care, reduce liability, and facilitate conversation among staff and physicians to identify opportunities to increase patient safety.
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