Measuring and Improving Ambulatory Patient Safety with an Electronic Dashboard

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Project Details -
Completed

Patient safety is a major public health challenge in the United States. Among ambulatory patients, safety problems include missed and delayed diagnosis, poor monitoring, miscommunication, and adverse drug events. Lack of timely information and fragmented care in ambulatory health systems exacerbate these problems. In safety-net health systems, where patients experience unique barriers to healthcare and health information technology (IT) infrastructure is less robust, these safety risks are likely to be even greater. Proactive and efficient strategies to detect high-risk situations in safety-net ambulatory care are urgently needed.

This project designed and pilot tested a dashboard that synthesizes patient data from a registry in an electronic health record to summarize safety measures at the patient level. The dashboard, named SAFE-D, is a real-time intervention that tracks and identifies patients who are overdue for anti-coagulant monitoring, and provides a mechanism to schedule appointments. SAFE-D was implemented in an anticoagulation clinic in an academic safety-net setting.

The specific aims of this project were as follows:

  • To develop an ambulatory safety electronic dashboard, with a visual summary of safety measures, for use in primary care settings. 
  • To conduct a pilot study to assess the feasibility of incorporating use of the dashboard in a primary care setting. 

Synchronizing real-time patient-level data required significant manual data entry and was most effective when a volunteer was dedicated to the project. SAFE-D was found to decrease the average monthly no-show rate by 10 percent. Additional post-implementation data were still being collected at the end of the project period. This pilot study informed the design of the AHRQ-funded grant (P30 HS023558-02) entitled Ambulatory Safety CEnter for iNnovaTion (ASCENT), a 4-year quality improvement study that seeks to design and develop workflows and health IT-facilitated interventions to improve the safety of ambulatory care.