When Things Go Wrong in the Ambulatory Setting
HCFA is one of a number of organizations involved in the PROMISES (Proactive Reduction of Outpatient Malpractice: Improving Safety, Efficiency, and Satisfaction) Project in Massachusetts. This project, which was funded through the federal Agency for Healthcare Research and Quality (AHRQ) Medical Liability Reform and Patient Safety Demonstration Grants, has been working to test interventions to improve safety in 16 ambulatory primary care practices.
The focus is on improving safety through improvement in test results management, referral management and medication management, with an overarching goal of improving communication (among staff, between providers and practices, and between staff and patients).
One of the areas that the PROMISES group, including HCFA, worked on was developing guidelines for primary care practices to follow when there has been harm caused to a patient. In 2006, Harvard hospitals came together to develop a document called When Things go Wrong which focused on the inpatient setting and the importance of disclosing errors to patients and families. The PROMISES group discussed the need for similar guidelines for the outpatient setting and together developed When Things Go Wrong in the Ambulatory Setting. HCFA is a co-author for an article about this document which was recently published in The Joint Commission Journal on Quality and Patient Safety.
This article will give national attention to these carefully considered guidelines, hopefully spreading their use not just in Massachusetts but across the country. These guidelines will be extremely useful as health care providers strive to carry out the apology and disclosure sections of the Massachusetts 2012 payment and delivery system reform law (Chapter 224).
You can see the guidelines on the PROMISES Project website, which includes the video above, featuring Dr. Lucian Leape, lead author of the original When Things Go Wrong document, and Dr. Gordon Schiff, lead primary care physician for the PROMISES Project, and case study videos.