Three questions with Sandeep Wadhwa, MD, MBA: Making ambulatory patients safer

I sat down with 3M Health Information Systems Global Chief Medical Officer Sandeep Wadhwa, MD, MBA, to discuss his thoughts on increasing ambulatory patient safety protocols.

Sandeep, you recently attended a meeting with chief medical officers (CMOs) from around the U.S. where the topic centered on the need to increase ambulatory patient safety protocols. Can you give us an overview?

Absolutely. Patient safety is always a topic of conversation, but what I heard loud and clear at this meeting was that ambulatory patient safety is top of mind for health system CMOs across the board. COVID-19 accelerated the shift in care provision to outpatient and virtual care settings, highlighting the need to establish a quality framework for outpatient care just like we have for inpatient. Everything from orthopedic procedures to implantable pacemakers to hernia repairs and cosmetic surgeries can be performed in outpatient settings. In large part because these are same day events, the culture of patient safety that exists in the inpatient environment doesn’t always translate to the outpatient or ambulatory setting.

A major area of agreement was that we need to get a handle on how health systems are using electronic health record (EHR) systems and data warehouses to better understand safety events and complication events with a real focus on making that patient experience better and safer. That involves linking interactions during a follow up period. More and more care and procedures are taking place in the outpatient setting and we want those procedures to be as safe and effective as humanly possible.

How could technology help identify areas of opportunity and help establish a patient safety framework?

In the inpatient world, where there are strong and clear safety frameworks, like the Centers for Medicare & Medicaid Services (CMS) “never events” and Agency for Healthcare Research and Quality (AHRQ) Inpatient Quality Indicators. These frameworks aren’t as robust in the ambulatory setting. There is also not a coordinated reporting structure or system that gives us the broad capability to identify safety defects or monitor and track performance of an individual provider or across an enterprise. Additionally, reporting systems are only as good as the information they are based upon, so accurate and complete documentation will be vital in establishing safety frameworks.

One area of interest to us is examining complication related emergency room visits or hospitalizations following an outpatient procedure. Examining the distribution, frequency and type of these adverse events and the procedures associated with them allows for focused quality improvement efforts. As this ambulatory procedure complication identification approach becomes more widely adopted, we will have more complete documentation of comorbidities at the time of the procedure. This will create an opportunity for flags or nudges to help clinicians mitigate risks associated with performing a procedure for a given patient. In the event of a subsequent visit, these same flags and nudges can inform the treatment team of any recent procedures, and ensure full documentation of present on admission (POA) status. These efforts will all allow for a more accurate understanding of complication rates and how to effectively reduce them.

What other stakeholders could be interested in increasing safety protocols to make ambulatory care as safe as possible?

I think health insurers, both private and government, are increasingly interested in supporting ambulatory safety to both advance patient safety and to promote more efficient care. Payers can play an important role because they have very complete data on care received after a procedure to analyze complication rates. Providers have access to more real time data, but less complete data when care occurs outside of a practice or health system. Partnerships on data sharing between health systems and payers can be effective in advancing patient safety. These partnerships will also be integral to population health management and value-based care efforts.

I also expect public quality reporting efforts to increasingly focus on ambulatory safety. As more and more procedures occur in outpatient settings, more visibility on adverse events and complications will also provide incentives for quality improvement. The efforts of these stakeholders will provide more tailwind to health systems to tackle these issues. We’re still in the early days of discussion, but without a doubt, technology will play a vital role in the tracking and reporting of issues and in establishing a solution to keep patients safer.

Sandeep Wadhwa, MD, MBA, is Global Chief Medical Officer at 3M Health Information Systems.

 Kelli Christman is senior marketing communications and strategic communications specialist at 3M Health Information Systems.

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