Patient Safety in Ambulatory Pediatrics
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Patient Safety (Ma Coffey, Section Editor)
Patient Safety in Ambulatory Pediatrics Kathleen Huth, MD, MMSc Arda Hotz, MD, MPH Amy J. Starmer, MD, MPH* Address * Department of Pediatrics, Boston Children’s Hospital, Boston, MA, USA Email: [email protected]
* Springer Nature Switzerland AG 2020
This article is part of the Topical Collection on Patient Safety Keywords Patient safety I Medical errors I Ambulatory care
Abstract Purpose of Review The majority of patient care occurs in the ambulatory setting, and pediatric patients are at high risk of medical error and harm. Prior studies have described various safety threats in ambulatory pediatrics, and little is known about effective strategies to minimize error. The purpose of this review is to identify best practices for optimizing safety in ambulatory pediatrics. Recent Findings The majority of the patient safety literature in ambulatory pediatrics describes frequencies and types of medical errors. Study of effective interventions to reduce error, and particularly to reduce harm, have been limited. There is evidence that medical complexity and social context are important modifiers of risk. Telemedicine has emerged as a care delivery model with potential to ameliorate and exacerbate safety threats. Though there is variation across studies, developing a safety culture, partnerships with patients and families, and use of structured communication are strategies that support patient safety. Summary There is no standardized taxonomy for errors in ambulatory pediatrics, but errors related to medications, vaccines, diagnosis, and care coordination and care transitions are commonly described. Evidence-based approaches to optimize safety include standardized prescribing and medication reconciliation practices, appropriate use of decision support tools in the electronic health record, and communication strategies like teach-back. Further high-quality intervention studies in pediatric ambulatory care that assess impact on patient harm and clinical outcomes should be prioritized.
Patient Safety (Ma Coffey, Section Editor)
Introduction The majority of pediatric care occurs outside of the hospital, yet there is a relative lack of data on medical error or patient harm in the ambulatory care setting. Preventing harm caused by clinical care is the central tenet of patient safety, a key healthcare quality domain identified by the Institute of Medicine [1]. Prior reviews have summarized patient safety concerns in ambulatory care [2], and more recently, there has been a call to prioritize ambulatory patient safety as a focus for further research [3]. With the growing complexity of pediatric care as well as evolution in how ambulatory care is
delivered, pediatricians face new challenges as well as new opportunities for ensuring safe care. This article reviews the epidemiology of key categories of safety threats in ambulatory pediatrics. We then describe best practices to minimize each category of errors, in order to maximize patient safety within this context. We
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