HM16 Presenters: Mangla Gulati, MD, FACP, FHM, and Ian Jenkins, MD
Summary: There is some evidence that hospital adverse events may be decreasing. The Agency for Healthcare Research and Quality (AHRQ) report of Partnership for Patients data found that there were 1.3 million hospital-acquired conditions prevented from 2011-2013, translating to 50,000 lives saved and $12 billion in savings. However, there is still much work to be done. Here are some major themes from the recent literature that may inform your own QI projects:
- Electronic medical records (EMR): Increased adoption raises concerns for unintended consequences which could detract from patient safety. These are derived from case reports, claims databases, reports through patient safety organizations. Consider reviewing alerts, advisories, and hard-stops within your hospital’s EMR.
- Improving diagnosis: Misdiagnosis affects 10% of Americans but measurement of this phenomenon remains difficult. Strategies to improve diagnosis include: focus on collaboration, teaching diagnostic skills, IT and algorithmic support, feedback and blame reduction, and reimbursement reform. There is growing recognition that hospitalists are well positioned to engage in these efforts.
- Hand hygiene: Multiple culture and environmental contributors to poor compliance (i.e., 40% compliance rate) and few good intervention studies. Recent studies have focused on the development of cause-specific plans and targeted interventions. Consider applying a targeted solutions tool to a project at your hospital.
- “Second victim”: Healthcare providers frequently experience emotional distress following patient safety events but there is a lack of resources to support providers after such an event. Consider implementing a “care for the caregiver” program at your hospital.
- Sepsis: North Shore-LIJ hospital system (in collaboration with the IHI) received the 2014 Eisenberg Award for developing and implementing a Sepsis Recognition Program and tool-kit. Such collaborations may be useful for driving and magnifying your QI initiatives.
- Patient experience: Recent studies emphasize the importance of patients being actively involved in their medical decisions and providing meaningful feedback. Consider implementing a patient/family council and getting involved with local patient experience initiatives.
- Incident reporting systems (IRS): Widespread under-reporting raises concerns over the value of IRS. Consider modifying or minimizing IRS and/or giving reports to local units to ignite safety culture.
- Discharge before noon (DBN): Delayed discharges may result in lost revenue and poor patient satisfaction. Wertheimer et al. reported on a successful intervention to increase DBN in the Journal of Hospital Medicine. Check out their intervention and consider something similar at your hospital.
- Patient monitoring: Vital sign measurements are often poorly timed, integrated and/or communicated. Recent studies of wireless Electronic Physiologic Surveillance System devices in hospitals have shown positive outcomes.TH