that patients continued to experience high rates of safety problems during hospital stays. Indeed, one study found adverse events continue to occur in as many as one-third of hospital patients (Classen et al., 2011). These adverse events occur in hospitalized patients even in regions where there has been a heavy programmatic focus on improving patient safety in hospitals (Landrigan et al., 2010). Safety problems also plague Medicare beneficiaries—a study suggests that more than 27 percent of Medicare beneficiaries will experience an adverse event during their hospitalizations, with half of these patients suffering more severe adverse events (HHS, 2010a).

These patient safety problems are not just limited to inpatient care. To Err Is Human recognized that more patients could be harmed by errors in ambulatory settings because more medical care is delivered outside of hospitals than inside. A recent review of malpractice claims concluded that 52 percent of all paid malpractice claims for all physician services involved ambulatory services, and almost two-thirds of these claims involved a major injury or death (Bishop et al., 2011).

Important differences exist between the inpatient and ambulatory settings regarding patient safety, including the types of errors seen (IOM, 1999), the relative importance of patient responsibility for following through on care decisions, and the different organizational and regulatory structures in place (Gandhi and Lee, 2010). As a result, it cannot be assumed that interventions to improve hospital safety will be applicable in the ambulatory setting, which deserves focused attention of its own. In recognition of this, an expert consensus conference to establish an agenda for research in ambulatory patient safety recognized that knowledge of ambulatory patient safety was lacking (Hammons et al., 2001). A recent 10-year review of ambulatory patient safety literature concluded that some progress has been made in understanding ambulatory safety, major gaps remain, and virtually no experiments or demonstrations have been done that show how to improve it (Lorincz et al., 2011).

This new refocus on patient safety as a specific system priority is best exemplified by a new Department of Health and Human Services (HHS) initiative with a sole focus on patient safety. Policy makers have recently recognized the significant challenges in improving patient safety across the continuum of care and the lack of progress over the past decade. HHS recently announced a national initiative called the Partnership for Patients, aimed at reducing preventable hospital-acquired conditions and complications, that would result in about 1.8 million fewer injuries to patients and would save more than 60,000 lives over 3 years. The partnership also aims to reduce preventable complications during care transitions, thereby cutting hospital readmissions by 20 percent from 2010 levels (HHS, 2011). This may herald a new national focus on patient safety over the next decade in the United States.



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