The American Medical Association (AMA) recently released a report on patient safety in ambulatory care settings between the years 2000 and 2010 revealing a gap in research on the subject. Although a plethora of research has been devoted to understanding and improving patient safety in hospitals and medical centers, research on outpatient or ambulatory safety has been lacking, according to the authors.

“Far more patients are cared for in ambulatory settings than are seen as inpatients; the harm that can occur in ambulatory settings is serious, and there are a number of ways in which the ambulatory setting is even more complex and prone to error than the inpatient setting,” the authors wrote.

The researchers examined 10 years’ worth of research on ambulatory safety and concluded that while some very high-quality work on the subject took place, research and initiatives in ambulatory safety were remarkably limited, both in quantity and in the ability to generalize from the studies that were reported. The authors noted that three general types of studies were reported over the last decade: research on events that caused harm to patients (often based on malpractice claims data or insurance claims), research on events that did not cause harm to patients, and, far less commonly, research on interventions that could improve patient safety.

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Patient safety issues that have been studied the most include medication safety, diagnostic errors, office-based surgery, and communication issues. The researchers concluded that despite more than 100 studies being conducted over the past decade, very little is known about ambulatory patient safety and “next to nothing about how to improve it.” Studies, the authors say, have often been too small, used conflicting taxonomies, and were sometimes derived from work in unique practice settings that might not provide generalized information. They concluded that the research base for ambulatory safety needs to be dramatically strengthened to provide enough information to make positive changes in patient care.