Despite significant strides in patient safety, significant gaps remain. Across the board, evidence-based practices have not been consistently implemented. Ambulatory settings remain understudied and lack safety infrastructure and systems. These issues are particularly acute in safety-net health care settings which disproportionately care for low-income, diverse, and vulnerable populations. Therefore, we propose to create a transdisciplinary patient safety learning laboratory, the San Francisco Ambulatory Safety CEnter for INnovaTion (ASCENT). 
We aim to bring together design thinking, reliability science, health system innovation and safety research to design and iterate technical and workflow solutions for high-priority ambulatory safety issues. Promising innovations will be implemented and evaluated in the San Francisco Health Network using implementation sciences methodology to assess reach, effectiveness, adoption, implementation, and maintenance. We plan to partner with closely affiliated safety-net innovation networks to disseminate and share successful innovations among safety-net health systems. ASCENT will focus on the following three high-priority ambulatory safety issues:

(1) test result management: when patients'diagnostic test results are not acted upon in a timely fashion, diagnostic delays and failures often ensue;

(2) monitoring for high-risk sub-populations: failures of monitoring for patients receiving high-risk treatments (such as anticoagulation or immunosuppression) can lead to adverse events. Use of team-based work-flow and electronic registry tools, de-coupled from visits has potential to enhance monitoring practices for high-risk patients;

(3) medication comprehension: patient medication self-administration has been implicated in outpatient ADEs, and validated methods to enhance comprehension have not been implemented systematically. ASCENT will have a scientific core of investigators that provide intellectual input on all projects.

An expert Advisory Board will provide insight into all projects, and front-line staff, clinicians, nd patients will provide substantive input through the innovation process. The long-term goal of the proposal is to create a sustainable pipeline of safety innovations from problem analysis through to clinical practice.