Practical Solutions to Improve Safety in the Obstetrics/Gynecology Office Setting and in the Operating Room

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There are great opportunities to enhance patient safety in office practice, but the pattern of medical errors and techniques to reduce their frequency appears to differ from the hospital environment. A focus on decreasing the risks of prescribing errors and tracking errors may be particularly fruitful in the office setting, such as electronic prescribing, electronic medical records, the use of detailed patient instructions, unambiguous prescribing, and meticulous follow-up of test results. The surgical environment presents its own unique set of risks to patient safety, particularly because of the catastrophic consequences that may result from even infrequent events. Vigilance against stress and fatigue is particularly important. Patient safety in surgery is promoted by routine use of the “universal protocol,” antibiotic prophylaxis, thromboprophylaxis, open communication among all members of the surgical team, and clear guidelines for introducing new procedures and technology.

Section snippets

Office setting

There is increasing recognition that clinical patient care in the ambulatory arena is subject to a different pattern of risks to patient safety than that found in the hospital environment [7]. For example, errors resulting from missed diagnosis appear to be much more common in office practice than in the hospital, at least based on data from closed malpractice claims [8]. As another example, of the four types of medication errors— prescribing (physician ordering), transcription and verification

Surgical environment

At times it may seem as though women's health care has become a less surgical specialty than it may have been in the past. The risks of surgical error in this specialty may have increased with the increase in caesarean sections and minimally-invasive surgery, including robot-assisted laparoscopy, and the pressures for shorter lengths-of-stay post operatively, as well as more out-patient surgery. More than 70 million in-patient and out-patient surgeries are performed each year in the United

Summary

The impact of medical error in office practice has been less well studied than in the hospital environment, but appears to present a significant potential risk to patient safety. Some principles and solutions appropriate to patient safety in the hospital may apply to office practice, while others may not; therefore it is particularly important for individual practices to examine their own procedures and outcomes and evaluate possible steps for improvement and the outcome of those initiatives.

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