Patient Safety Is Patient Care: Bringing an EBM Patient Safety Program to Ambulatory Care

Patient safety has traditionally focused on inpatient care with little focus and interventions in ambulatory care, largely due to the perception of more control in the inpatient environment. To build and sustain an ambulatory care safety program, leaders must prioritize patient safety, dedicating a team to report monitoring and analysis. The interdisciplinary team, including nursing, advance practice clinicians, physicians, practice leadership, risk management, coding and compliance, and patient relations, implemented evidence-based practice (EBP) interventions based on the change management theory. With an organizational goal of reducing preventable harm, the goal was to establish a separate, non-acute focused, EBP patient safety program unique to ambulatory care by increasing event reporting by 5%. Baseline data of ambulatory care event report numbers were obtained from the organization’s event reporting platform for the intervention period dates one year prior. The baseline average event report submission per month for October 2022 to April 2023 was 111.
Multiple layered EBP interventions were implemented including defining metrics and establishing standard reports for tracking metrics, identifying ambulatory caregivers for event report analysis, shortening the event report form and reducing the use of technical terms, performing leadership rounding and facilitating caregiver recognition, and consistently communicating safety metrics. The creation of a shortened event report form with fewer technical terms was piloted in six primary care practices from June to October 2023. Due to increased event report submissions, the shortened event review form was introduced enterprise-wide in November 2023. This, in addition to the introduction of a monthly ambulatory care safety newsletter in January 2024 as well as close adherence to regular presentations using a cohesive image and consistent metric reporting beginning in November 2023, aligns with the increase in ambulatory care event reports.
Baseline data reflecting the number of event reports submitted between October 2022 and April 2023 show an average of 111 ambulatory care event submissions per month. Following the application of multiple EBP interventions aligned with the change management theory, the average number of ambulatory care event submissions per month increased to 124. The key measurement was a 11.7% increase in ambulatory care event report submissions, The results demonstrate the effectiveness of the interventions and surpassed the 10% reach goal.
The goal of increasing ambulatory care event submissions was met and surpassed. The results indicate an 11.7% increase from October 2023 to April 2024 compared to the same period the year prior. Multifaceted, layered interventions with an audience of interdisciplinary caregivers provided an effective mechanism.
Lessons learned include the broader scope of repetitive, consistent messaging coupled with specific relationship building is foundational to establishing engagement in event reporting at the local level. Awareness of the shortened event report form as well as identification of local practice safety champions continue to be opportunities moving forward. The ambulatory care patient safety program is designed to be replicated either as a whole or using individual interventions over time, based on an organization’s or department’s resources.