response 1

Original instructions:

Quality and safety measures vary greatly from an inpatient setting, where people are cared for episodically, to an ambulatory care setting, where they are seen over time.

In your initial post, address the following:

  • Briefly compare and contrast quality initiatives in these different settings.
  • Describe how in an ambulatory care setting you could develop a patient safety strategy to foster population health based on the five target areas described in Chapter 14 of your textbook.
  • Provide concrete examples of a strategy for each of these five target areas.

Peer’s Post that needs a response:

De la Cruz Rodriguez


Ambulatory and Inpatient services can often be misunderstood by those who need to become more familiar with what they both offer. The ambulatory setting is based on patients’ stable health to prevent future hospitalizations. Examples of these ambulatory settings are primary care and subspecialist offices, urgent care centers, and ambulatory surgery, with different inpatient settings, including hospitals, emergency departments, medical-surgical facilities, and skilled nursing facilities. Providers and insurance companies have tried to implement an initiative to have patients use ambulatory services before visiting an inpatient scenario. For example, insurance companies and primary care providers often work together to seek patient compliance with preventive screening labs and procedures such as mammography, colonoscopy, vaccinations, and diabetic eye exams. This is to avoid hospitalizations and deterioration of health and, therefore, reduce costs by avoiding highly-priced hospital admissions. The ambulatory care scenario presents the following challenges: Medication Errors, Adverse drug events, Missed/Incorrect/Delayed diagnoses, and Delay of proper treatment of preventive services, Nash, D. B., Joshi, M. S., Ransom, E. R., & Ransom, S. B. (2019).

Medication Error: Medication error is a huge challenge that can be seen or possible in ambulatory settings. This challenge represents a safety issue for patients since the administration of a medication that is not the right one can transcript in delays of treatment, recovery, complications in patient health, and sometimes even death. Therefore, it is necessary to improve patient safety protocols to minimize and avoid errors continually. Technology must be used to ensure patient safety with medication administrations, as initiatives like the Pixis machine and scanning medication with patient bands to prevent patient mistakes are often implemented in these scenarios. Many of the early studies of medication safety in primary care were published before the electronic health record (EHR) era, Espinoza, A., Gurses, A., Fulda, K., et. al


Adverse drug events: In ambulatory scenarios, it is essential to take into account initiatives to prevent or be prepared for possible adverse effects or events due to medication administration. This is so important in ambulatory services because patients don’t spend a night admitted. Therefore, a more precise monitoring of health is required to make sure the patient is not going to suffer adverse events when he is discharged to his home; for this, an initiative like a checklist of patient symptoms by the hour, for example, every 30 minutes or an hour, depending on which medication was administered. 

Missed/Incorrect/Delayed diagnoses: Not all ambulatory scenarios have a Triage process, which is our tool for identifying possible diagnoses or problems affecting our patients. For example, a good initiative would be to implement a process similar to a hospital triage in primary care office providers as well as other specialists to determine the priority of treatment and prevent possible delayed diagnoses as some patients might start experiencing specific symptoms characterized by things like a heart attack or stroke and not identifying this symptom as soon patients arrive to ambulatory scenarios might complicate patient health. 

Delay of proper treatment of preventive services: Sometimes, patients might be confused about what ambulatory vs inpatient services might benefit them. For example, patients might visit a walking scenario like their primary care provider before they see an ER or hospital as they might try to avoid getting admitted; however, depending on the patient’s current health state, it might not be on time to seek ambulatory services as their symptoms have already progressed a lot. Another example might be if patients are not very involved in their care and their PCP is not ordering annual preventive services like mammography, colonoscopy, vaccinations, and diabetic eye exams.

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