Clinical Report: Exploring Ambulatory Care Patterns to Understand Inpatient Diagnostic Risks

Overview

This study investigates the relationship between pre-admission ambulatory encounters and the risk of harmful diagnostic errors during hospitalization. It identifies that patients with two or more outpatient visits in the 14 days prior to admission have more than twice the odds of experiencing such errors.

Background

Diagnostic errors are a significant source of patient harm, with many individuals experiencing at least one during their lifetime. This study highlights the role of pre-admission care patterns in identifying patients at risk for diagnostic errors.

Data Highlights

Key Findings

• Patients with two or more ambulatory encounters in the 14 days before admission had over twice the odds of harmful diagnostic errors.
• Traditional markers of complexity did not show a statistically significant association with harmful diagnostic errors.
• The study was underpowered, which may affect the reliability of its findings.
• The distinction between prediction and causation is critical in interpreting the results.
• Increased pre-admission utilization may indicate unresolved diagnostic uncertainty rather than a direct cause of diagnostic errors.

Clinical Implications

Hospitalists should consider patients with multiple outpatient visits before admission as potentially vulnerable to diagnostic errors.

Conclusion

The findings of this study suggest that the transition from ambulatory to inpatient care warrants further investigation.

Related Resources & Content

1. Goyal, M., et al., Journal of General Internal Medicine, 2023 -- Exploring Ambulatory Care Patterns to Understand Inpatient Diagnostic Risks
2. Clinical Rheumatology — Risk Assessment for Hospitalization in Gout Patients Presenting to the Emergency Room
3. Pediatric Cardiology — Investigating the Impact of Social Health Determinants on Avoidable and Emergency Readmissions in Pediatric Cardiology Acute Care
4. Outpatient Treatment Approaches for Acute Uncomplicated Diverticulitis: Findings from the AmbUDiv Multicenter Propensity Score Matched Analysis
5. Defining Diagnostic Excellence and Missed Diagnostic Opportunity for the Emergency Department Setting
6. Aligning Patient Safety Event Reporting: 2025 Updates to Sentinel Events and Serious Reportable Events
7. Adverse diagnostic events in hospitalised patients: a single-centre, retrospective cohort study - PubMed