Data-Driven Priorities in Ambulatory Care

As medical care continues to shift from hospitals to outpatient settings, projected to grow by 5 percent total between 2024 and 2030, the risk of medical errors follows close behind. Several forces are driving the increased demand for ambulatory care, including an aging population, the rapid expansion of ambulatory surgical centers, rising health care costs for patients, and the growing prevalence of chronic conditions such as diabetes and cardiovascular disease. For many of these patients, receiving treatment in outpatient facilities is more cost-effective than inpatient care, further accelerating the shift.

According to Candello, cases originating in ambulatory settings accounted for approximately 49% of more than 67,000 malpractice claims asserted between 2014–2024.

What goes wrong?

Diagnostic errors

Diagnosis-related allegations, especially those involving cancer, cardiovascular disease, and infections, are one of the most common among ambulatory cases, with about two-thirds resulting in clinically severe outcomes. Out of almost 7,500 cases that involved a diagnosis-related allegation, 44% involved errors in diagnostic processing, 44% in patient assessment and evaluation of symptoms, and 41% in ordering of diagnostic or lab tests.

Ambulatory surgical procedures

Ambulatory surgery, while generally safe and efficient, presents a significant malpractice risk, with cases highlighting three common contributing factors. The most common driver is technical performance issues tied to known complications (56% of asserted cases), underscoring how even anticipated risks can escalate into claims when outcomes deviate from expectations. Nearly as frequent are errors in selection and management of therapy (41%), where inappropriate patient candidacy or misaligned treatment choices increase vulnerability. Finally, in 20% of cases, patients sought care elsewhere due to dissatisfaction, reflecting how breakdowns in communication and trust can amplify perceived harm and motivate litigation. Together, these patterns reveal that both clinical precision and patient relationship management are critical in mitigating risk.

Medication errors

Even though medication-related errors only make up 7% of medical malpractice cases here, MPL data only represent the tip of the iceberg. One review of more than 3,000 outpatient charts identified that approximately 64% of these involved a possible adverse drug event. Pharmacist-led interventions can meaningfully reduce adverse drug events in these settings. However, research also indicates that technology alone, such as electronic health record alerts, has limited impact unless coupled with active clinical oversight and patient education.

Moving from Awareness to Action

Inpatient safety has improved thanks to years of focused attention, but outpatient safety hasn’t received the same level of priority or resources. Data from malpractice claims and safety studies now make it clear that ambulatory care needs equally strong protections. While there is still much work to do, some promising interventions in this setting include:

1. Ambulatory Safety Nets (ASNs)

   Ambulatory safety net programs integrate tracking and monitoring systems, patient navigation, and standardized workflows with robust communication infrastructure to address follow-up gaps in abnormal test results. Evidence demonstrates their effectiveness in reducing delays and mitigating missed diagnoses. Kaiser Permanente’s SureNet colorectal abnormal screening notification system, for instance, achieved a 24% reduction in mortality across seven years.

2. Structured Teamwork and Communication Tools

   Enhancing teamwork and communication can counteract the fragmented nature of outpatient care. For example, the TeamSTEPPS program is an evidence-based teamwork and communication framework from the Agency for Healthcare Research and Quality (AHRQ); its modular, active-learning curriculum for frontline providers promotes patient-centered care through communication tools, situation monitoring, leadership, and mutual support, while addressing telehealth, diverse workforces, and burnout in ambulatory teams.

3. Patient Journey Mapping
   Patient journey mapping is a relatively novel method that can offer a powerful and pragmatic lens to pinpoint friction in the patient experience, such as scheduling delays, communication breakdowns, and care fragmentation. and helps clinics streamline workflows, boost patient engagement, and optimize resource use; a 2025 review found that journey mapping in chronic disease management may significantly enhance care efficiency, quality, patient engagement, and resource allocation.

Additional Resources

• Ambulatory Care Safety | PSNet
• Ambulatory Safety Nets