The focus on patient safety and efforts to avoid medical malpractice in recent years has been on problems in hospitals rather than
in outpatient settings such as doctors’ offices and urgent-care centers. Hospitals have been the main target for malpractice investigations and have come under scrutiny for medication errors, hospital-acquired infections wrong-site urgeries.

However, a recent study in the Journal of the American Medical Association found that serious errors that result in malpractice awards also regularly take place in outpatient settings, suggesting that attention needs to be paid to the mistakes that happen outside the hospital.

The study found that of 10,739 malpractice claims paid on behalf of physicians in 2009, 48 percent were in the inpatient setting and 43 percent were in the outpatient setting. Nine percent of payments involvedevents that occurred in both settings. The study also found that the amount of malpractice payouts for errors that occurred outside hospital settings increased from 2005 to 2009.

Most people receive health care in outpatient settings: There are more than 950 million visits to physician offices a year, compared to just 34 million hospital discharges, according to the Centers for Disease Control and Prevention.

Study author Dr. Tara Bishop of Weill Cornell Medical College in New York told Reuters, said she was surprised by the findings but
admitted that as more invasive and high-technology procedures are being performed in the outpatient setting, there is a higher risk for malpractice just as there would be in a hospital.

Misdiagnosis errors were the number one reason for events that resulted in malpractice lawsuits in outpatient settings, while surgical errors were the number one mistake among hospitals.

Unfortunately, although more care is being taken to avoid medical malpractice in doctor’s offices, it is often more difficult to address. In outpatient settings, doctors must trust that patients will follow their instructions, since they cannot monitor the patient like at a hospital.

Sometimes, small doctor’s offices may not have the resources or staff to tackle tough quality and safety issues. If patients see more than one doctor, there is room for error and treatment may fall through the cracks.