AHRQ funding safety research in ambulatory care

Researchers across the country received $3.7 million to find ways to improve safety and reduce medical errors in settings such as emergency departments, primary care physician offices and community pharmacies.

The funds from the Agency for Healthcare Research and Quality support three-year projects designed to identify, develop, test and implement safer practices in ambulatory care settings. Ultimately, researchers and AHRQ will develop toolkits to share the findings and lessons learned with physicians, hospitals and others in health care settings.

About a dozen projects received grants in September 2008. Among the winners is an investigator examining ways to ensure that test results from multiple laboratories and imaging centers make it back to the primary care physician. He also is looking at how test results are communicated to the patient in a timely, effective way. It is a particular challenge in the community health center setting where the principal researcher, Milton "Mickey" Eder, PhD, works.

"We are hoping ... to develop tools that have to do with principles of safe office practice," said Eder, director of research programs at Access Community Health Network in Chicago.

During the risk-assessment phase of the project last year, Eder and his team determined that the more institutions involved, the bigger the challenges. And dealing with multiple entities is not uncommon in physician offices. For example, different health plans may expect samples to be sent to different labs. Each lab has its own protocol, making it difficult to have a standard procedure, he said.

Eder said researchers hope to develop two or three levels of materials for physician offices to use to improve how they handle test results. They are looking at paper-based and Web-based materials, as well as CDs.

"We want to make it user-friendly so practices can pick them up and use them without technical support," said Eder, whose project received $295,093. "There is a wide spectrum of community-based and private practices, and they are going to have a range of IT facilities and support."

Reducing system pressures

Other projects that received AHRQ risk-informed intervention grants are looking at ways to:

• Reduce system pressures that negatively influence behavior and create unsafe operating conditions with sedation in ambulatory settings. Beth Israel Deaconess Medical Center in Boston received a grant of $229,674.
• Improve transitions from neonatal intensive care units to outpatient follow-up, with $299,764 going to Baylor College of Medicine in Houston.
• Lower the number of medication errors associated with high-risk medication by improving laboratory monitoring. A grant of $287,298 went to the University of Massachusetts Medical School.
• Implement interventions at community pharmacies to reduce, eliminate or mitigate risks and hazards tied to certain medications; $298,401 went to the Institute for Safe Medication Practices in Horsham, Pa.

Kendall K. Hall, MD, assistant professor of emergency medicine at the University of Maryland School of Medicine, is the principal investigator on a project aimed at improving safety in the emergency department.

During the first round of grants in 2007, her team conducted more than 1,100 interviews with people involved in more than 400 ED visits. The team concluded that errors were not big adverse events. Instead, problems were found in diagnostics, such as missing lab results.

The $278,410 grant will allow her to "develop a tool so that doesn't happen," Dr. Hall said.

Things happen fast in the emergency department, and nurses, physicians and others need to be able to look in one area quickly to determine what tests have been ordered and what medication has been given, she said.

"We believe we have to start with the basics," Dr. Hall said. "We plan to start with a paper tool and then build a more technologically-based one."