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JAMA study: Malpractice events more common in outpatient settings
Hospital risk managers and policymakers have been focusing on inpatient safety, but in 2009 more than half of malpractice events occurred in the outpatient setting, report researchers in the June 15, 2011 Journal of the American Medical Association.

“This unrecognized risk, and the associated absence of risk management programs in ambulatory care settings across the country, is a cause for concern. The study is a wake-up call for physicians who practice primarily in ambulatory settings and for physicians and administrators with the ability to set policy for these areas,” JAMA noted in an editorial.

Researchers using data from the National Practitioner Data Bank found that although the total number of claims gradually decreased between 2005 and 2009, the rate of this decline was slower in the ambulatory setting and there was a small but statistically significant increase in the percentage of events occurring in outpatient areas. “Furthermore, the outcomes of outpatient events were not trivial – major injury or death accounted for almost two-thirds of paid claims for events in the outpatient setting,” the researchers reported.

Although the comparative risks may be lower in the outpatient setting given that there are almost 30 times more outpatient visits than hospital discharges annually, the risks are real. The researchers noted that more invasive and high-technology diagnostic and therapeutic procedures are increasingly being performed in the outpatient setting, sometimes in physician offices or small ambulatory surgical centers that may not have the same safety controls as hospitals.