General practitioner and nursing assistant

Patient safety in the outpatient setting

For a long time, patient safety initiatives focused only on the inpatient sector. Therefore, the outpatient segment has still work to do and is one of the Foundation's priority areas.

The outpatient sector becomes more important

  • The majority of patient contacts take place in the outpatient sector.
  • Hospital stays are becoming shorter, follow-up and further treatment are being shifted.
  • Therapies are increasingly being carried out on an outpatient basis, including complex treatments.
  • The number of chronically and multiply ill patients increases the need for outpatient care.

According to the OECD, safety problems are common in the outpatient sector.

  • Up to four out of ten patients are harmed in the course of their outpatient care.
  • Up to 80% of patient harm is preventable.
  • The additional costs amount to about 2.5% of national health expenditure.

Catching up on research and developments

More in-depth knowledge about the development and prevention of safety issues in the outpatient sector is needed. Suitable measures must be developed and implemented. Together with the FMH, the Foundation has developed an outline of approaches and measures for the promotion of patient safety in outpatient medical care. This forms the basis for further activities and projects.

Current projects

Quality circles for patient safety

Quality circles (QC) are an important place for exchange and knowledge transfer, but also for patient safety issues.

Quality circles offer a trusting framework and enable active discussion of a wide range of topics. This also includes sensitive patient safety topics, such as dealing with risks and errors. For this reason, Patient Safety Switzerland, with financial support from the FMH, is developing materials for quality circles for the communication and discussion of fundamental patient safety topics. The new materials will be used and evaluated in various quality circles in the second half of 2021.

Room of Horrors in the medical office

In a Room of Horrors, health professionals can train situational awareness for patient hazards in a fun way.

Here's how it works: When the doors of the practice are closed to patients, errors and risks that pose a threat to the safe care of patients in the practice are deliberately installed. The practice team has the task of uncovering all risks and discusses them afterwards in a debriefing.

>>> Find out more (in German) ...

Other projects related to the outpatient sector

  • Speak Up

  • Health Information Technology (HIT)

  • CIRS

Completed projects

Risks in primary care

Patient Safety Switzerland conducted a study on risks in primary care with over 400 practices.

The study resulted in relevant findings regarding the nature and frequency of safety problems in outpatient healthcare. The project developed an instrument to survey the safety culture in primary care.

The following areas proved to be particularly relevant for action:

  • Diagnostic errors
  • Medication errors
  • Errors in monitoring patients in the practice
  • Errors in tests and interventions
  • Concern: Triage when patients contact the clinic by telephone

>>> More ...

Telephone triage in primary care

Telephone triage when contacting a doctor's office is a hot-spot of patient safety. Misjudgments of the urgency of the patient's concern are not uncommon.

The risk associated with telephone triage is of great importance for both doctors and MPAs. International studies are also increasingly pointing this out. Patient Safety Switzerland therefore launched the project safety of telephone triage in primary care in 2013, in which a practical guide for primary care practices was developed.

Guideline for staff in primary care practices

The guidelines are a working tool that guides practice teams in analyzing the structures and framework conditions surrounding telephone triage and its effects on patient safety. In a second step, measures can be developed to strengthen the safety of telephone triage in the practices. The core of the guide consists of seven modules on the topics: Expectations in the practice team, questions for the doctor, feedback for the MPA, communication and communication vessels, case discussions, learners in the practice and work (place) design.

Pharmacy customers with a migration background

Incidents in connection with medicines are particularly frequent among migrants because of the often limited communication.

Pharmacies play an important role in the health care of migrants. A study conducted by Patient Safety Switzerland in 2021 showed that pharmacists surveyed consider the drug therapy of migrants to be less safe than that of other customer groups. Improvement measures are consequently required. Pharmacists are very interested in tools such as labelling software and online texts in foreign languages, but also pictograms and illustrated instruction templates. Based on the study results, a further training module on the topic of «Religious and linguistic diversity in the pharmacy» was developed by an external provider.

>>> Final report 2012

Pharmacies as a source of information

Transitions between treatment sectors are dangerous phases for medication safety. Systematic medication reconciliation is an effective measure.

Since patients often use pharmacies as their regular pharmacy, this pharmaSuisse-funded project in 2015 aimed to explore the role and possibilities of pharmacies as a source of information for the collection of medication history on hospital admission. The study showed that surveyed pharmacies have a good knowledge of regular customers, although there are also information gaps. Pharmacies thus have information that is important for compiling a complete pre-hospital medication list. They would be willing to participate more in this, but would also like information at hospital discharge. The exchange of information between pharmacies and hospitals could therefore improve medication safety; the areas of data protection, information transfer and processes, as well as a mutual recognition of competences, must be discussed and clarified.

>>> Executive Summary

Dr. Katrin Gehring
Head of Outpatient Sector
+41 43 244 14 95