Serious adverse events frequent in outpatient care, review finds
Seven percent of outpatients experienced at least one adverse event, with drug events being the most common (63.8%), followed by health care-associated infections (14.8%) and surgical or procedural events (14.2%), according to an analysis of Massachusetts clinics.
Adverse events during outpatient care are relatively common and often serious, with drug events accounting for about two-thirds, a study found.
Researchers conducted a retrospective review of health records for 3,103 patients at 11 outpatient sites in Massachusetts during 2018. Nurse reviewers identified possible adverse events and physicians adjudicated them, ranked severity, and assessed preventability. The review was published May 7 by Annals of Internal Medicine.
Seven percent (95% CI, 4.6% to 9.3%) of outpatients experienced at least one adverse event (8.6 events per 100 patients annually), the review found, with drug events being the most common (63.8%), followed by health care-associated infections (14.8%) and surgical or procedural events (14.2%). Severity was judged to be serious in 17.4% of events and life-threatening in 2.1%. None of the events were fatal; 23.2% were deemed preventable.
Patients ages 18 to 44 years were less likely to have an adverse event than those ages 65 to 84 years (standardized risk difference, −0.05; 95% CI, −0.09 to −0.02); risk was also higher in Black patients than in Asian patients (standardized risk difference, 0.09; 95% CI, 0.01 to 0.17). Across study sites, 1.8% to 23.6% of patients had at least one event, with substantial variation in clinical category.
According to the authors, these data serve as an urgent call for patient safety research and innovation in the outpatient setting. They suggested routine and standardized systems to track and intervene on outpatient adverse events.
An accompanying editorial noted that increasing use of patient portals and artificial intelligence in health care settings can enable research on outpatient safety but stressed that a more human touch is also needed.
"The missing ingredient in outpatient safety interventions may be patient and family engagement," the editorial stated. "The current study shows that outpatient care carries a significant risk for adverse events and underscores the importance of harnessing novel methods, digital approaches, and partnerships with patients and families to move beyond the long-standing status quo."