Preventing Errors In The Outpatient Setting: A Tale of Three States

Elizabeth M. Lapetina and Elizabeth M. Armstrong


Health Affairs. 2002;21(4) 

In This Article

Paths to Outpatient Safety

The examples of New Jersey, New York, and Florida are not enough to draw complete conclusions about the best way to implement standards for office-based surgery. However, it is clear that New Jersey was most successful in its efforts to implement standards by concentrating on developing regulations rather than legislation. Other states should work with their boards of medical examiners and departments of health to provide equally rigid standards in hospitals, ambulatory surgical centers, and physician offices. Although medical examiners boards do feel pressure from competing physician specialties, legislators are likely to feel these same pressures, plus outside pressure from special-interest lobbying groups and fellow political party members. Legislation may be useful as a complement to regulations. New agencies or regulatory bodies may be created through legislative action to monitor the adherence of office facilities to newly established standards. What is most important, however, is that both legislation and regulations be developed proactively, rather than as reactive measures implemented in response to news of alarming events in the outpatient setting.

To encourage this state action, the U.S. Department of Health and Human Services (HHS) should mandate that all states create standards of care for office-based surgery and procedures involving anesthesia within a designated number of years. The standards should address areas including patient monitoring during procedures, technology implementation, and equipment purchase and maintenance. Additionally, statewide required reporting systems should be established for the purpose of gathering information about the frequency and nature of adverse events and near-misses. This information could then be analyzed and compared to determine which aspects of office-based medicine need to be altered to prevent additional medical errors.

Greatly reducing the number of medical errors associated with office-based procedures should be part of the effort to improve health care quality. To protect the public from unqualified providers, state regulations are needed to define the qualifications to perform particular procedures, as well as the setting in which such procedures may take place. New Jersey, New York, and Florida have pursued very different paths to outpatient safety. Of these three, New Jersey's comprehensive and collaborative approach promises to yield the greatest improvement in health care quality.


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