Although much research has been devoted to understanding and improving patient safety in hospital and medical centers, research in ambulatory care settings is lacking, according to a report from the American Medical Association’s (AMA) Center for Patient Safety.

The report, which reviewed research published on the topic of patient safety between 2000 and 2010, reveals that a research gap exists. In the 10 years worth of research examined, the researchers concluded that although some high-quality work on the subject has taken place, research and initiatives in ambulatory safety were remarkably limited, both in quantity and in the ability to generalize from the studies that were reported.

“Far more patients are cared for in ambulatory settings than are seen as inpatients; the harm that can occur in ambulatory settings is serious, and there are a number of ways in which the ambulatory setting is even more complex and prone to error than the inpatient setting,” the AMA wrote.

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During the past decade, the research conducted falls into three general categories: research on events that caused harm to patients, often based on malpractice claims data or insurance claims; research on events that did not cause harm to patients; and, less commonly, research on interventions that could improve patient safety. 

Patient safety issues that have received the most attention include medication safety, diagnostic errors, office-based surgery and communication issues.

Despite the more than 100 existing patient safety studies, the researchers concluded that very little is known about ambulatory patient safety and “next to nothing about how to improve it.” Additional problems identified include small study size and often-conflicting taxonomies derived from unique practice settings that are not easily generalizable.

The research base for ambulatory safety needs to be dramatically strengthened in order to provide enough information to make positive changes in patient care, the researchers concluded.


Lorincz CY, Drazen E, Sokol PE et al. “Research in Ambulatory Patient Safety 2000–2010: A 10-Year Review.” American Medical Association, Chicago: 2011.