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July/August 2014
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Perspectives on Safety
Safety in the Ambulatory Setting
INTERVIEW
In Conversation With… Urmimala Sarkar, MD, MPH
Dr. Sarkar is an associate professor of medicine at UCSF whose research has focused on ambulatory patient safety, including missed and delayed diagnosis, adverse drug events, and monitoring failures for outpatients with chronic diseases. We spoke with her about patient safety in the ambulatory setting.
(.MP3 | 10.0 MB)
PERSPECTIVE
Beyond the Hospital: the New Frontier of Patient Safety
by Margaret Plews-Ogan, MD, MS
This piece describes the new landscape of patient safety in outpatient care, including elements adapted from hospital settings and the growing evidence base for ambulatory-specific efforts.
Cases & Commentaries
SPOTLIGHT CASE
Admitted with bruising from a fall and persistent pain on his left side, a patient was kept in the emergency department overnight due to crowding. After being reevaluated by the surgical service the next day, the patient was urgently taken to the operating room for probable necrotizing fasciitis and pyomysitis.
Commentary by Terence Goh, MBBS, and Lee Gan Goh, MBBS
CME/CEU credit available for this case

Presenting with jaundice and epigastric pain, a woman with a history of multiple malignancies was admitted directly for an ultrasound-guided liver biopsy. After the procedure, the patient had low blood pressure and complained of new abdominal pain, which worsened over the next 2 hours. The bedside nurse soon found the patient unresponsive.
Commentary by Don C. Rockey, MD

During a code blue, an intraosseous line was placed in the left tibia of an elderly woman after several unsuccessful attempts to obtain peripheral venous access. Following chest compressions and advanced cardiovascular life support protocol, spontaneous circulation returned and the patient was transferred to the intensive care unit. A few hours later, the left leg was dusky purple with sluggish distal pulses.
Commentary by Raymond L. Fowler, MD, and Melanie J. Lippmann, MD
Photograph of doctor using a computer
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