Patient-Reported Safety and Quality of Care in Outpatient Oncology

Background: Although patients suffer the effects of medical errors and iatrogenic injuries, little is known about their ability to recognize these events in ambulatory specialty care. Methods: At a Boston cancer center in 2004, 193 adult oncology patients treated on a chemotherapy infusion unit were interviewed by four patient safety liaisons-volunteers recruited from the organization's Adult Patient and Family Advisory Council. Results: Among 193 patients, 83 reported 121 incidents. Investigators classified 2 (1%) adverse events, 4 (2%) close calls, 14 (7%) errors without risk of harm, and 101 (52%) service quality incidents. Respondents reported high staff compliance with safe practices such as identity checking (95%). Examining the most serious event described by each of 42 (22%) respondents who reported a recent unsafe experience, investigators classified only one adverse event, 3 close calls, 9 harmless errors, and 27 service quality incidents. Discussion: Patients' perception of unsafe care was surprising, given the same patients' recognition of consistent application of safe practices, such as the use of two forms of identification before performing tests and administering treatments. Many ambulatory oncology patients also reported poor service quality. The relationship between patient perception of safe care, medical injury, and service quality merits further study.