Ambulatory Safety Nets to Reduce Missed and Delayed Diagnoses of Cancer

Jt Comm J Qual Patient Saf. 2019 Aug;45(8):552-557. doi: 10.1016/j.jcjq.2019.05.010. Epub 2019 Jul 6.


Background: An ambulatory safety net (ASN) is an innovative organizational intervention for addressing patient safety related to missed and delayed diagnoses of abnormal test results. ASNs consist of a set of tools, reports and registries, and associated work flows to create a high-reliability system for abnormal test result management.

Methods: Two ASNs implemented at an academic medical center are described, one focusing on colon cancer and the other on lung cancer. Data from electronic registries and chart reviews were used to evaluate the effectiveness of the ASNs, which were defined as follows: colon cancer-the proportion of patients who were scheduled for or completed a colonoscopy following safety net team outreach to the patient; lung cancer-the proportion of patients for whom the safety net was able to identify and implement appropriate follow-up, as defined by scheduled or completed chest CT.

Results: The effectiveness of the colon cancer ASN was 44.0%, and the effectiveness of the lung cancer ASN was 56.9%. The ASNs led to the development of registries to address patient safety, fostered collaboration among interdisciplinary teams of clinicians and administrative staff, and created new work flows for patient outreach and tracking.

Conclusion: Two ASNs were successfully implemented at an academic medical center to address missed and delayed recognition of abnormal test results related to colon cancer and lung cancer. The ASNs are providing a framework for development of additional safety nets in the organization.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Academic Medical Centers / organization & administration*
  • Academic Medical Centers / standards
  • Ambulatory Care / organization & administration*
  • Ambulatory Care / standards
  • Colonic Neoplasms / diagnosis
  • Colonoscopy / statistics & numerical data
  • Delayed Diagnosis / prevention & control*
  • Early Diagnosis
  • Humans
  • Lung Neoplasms / diagnosis
  • Program Evaluation
  • Registries / standards*
  • Thorax / diagnostic imaging
  • Workflow