Patient safety is a broad initiative for hospitals everywhere. Measures are put into place using financial benefits and penalty systems to ensure that hospitals are staying compliant. These measures come in the form of core measures and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), for example. Through the National Patient Safety Goals initiative, The Joint Commission is also holding hospitals accountable for their actions concerning the patient’s safety. Failure to comply with these various measures results in penalties, and the healthcare industry is struggling to find ways to stay compliant.
Leadership: Implementing Change
Implementation of patient safety initiatives cascades down from the top, promoting a culture of safety for the employees who work directly with patients. In 2016, the healthcare landscape transitioned the industry from volume-based care to value-based care. Now, more than ever, leadership is in a position to implement change in a way that instills a paradigm of safety in each patient room.
To illustrate, healthcare acquired-infections (HAIs) and falls are at the top of the list of patient safety issues hospitals are facing today.
According to the National Patient Safety Foundation (NPSF), one out of every 20 patients contracts a HAI. These infections include Catheter-Associated Urinary Tract Infection (CAUTI), central-line blood infection, surgical site infections and hospital-acquired pneumonia, to name a few. HAIs can be reduced or prevented entirely by implementing performance standards set out by the Joint Commission and the Center for Disease Control (CDC) with established requirements to prevent adverse events. While these and other standards have been put in place and are part of initiatives practiced by virtually all hospitals in the United States, healthcare organizations continue to grapple with repeated sentinel events. Along with additional costs of treating HAIs, there are other issues that plague healthcare organizations as a result of these infections, including increased length of stay (LOS) and readmission, both being very costly for the patient and the hospital.
“The average increase in a hospital’s operational costs for a serious fall-related injury is more than $13,000, and the patient’s length of stay increases by an average of 6.27 days.”
Similar to HAIs, patient falls are a prevalent issue in healthcare that can be very costly. While no fall is an acceptable fall, all falls are expensive and counterintuitive to organizations aiming to heal. Patients should feel that the hospital room is the safest place for them during their care. While standards and preventative measures are in place to reduce the frequency and severity of falls, they still happen. It is estimated that there are more than 500,000 patient falls annually, with 150,000 of them resulting in injury. A fall without injury is estimated to cost nearly $4,000 per fall. A fall with an injury can cost on average $20,000-25,000. Nearly $1.4 billion is spent annually on falls, while falls with injury can cost nearly $3.75 billion annually. Additional varying data is available from The Joint Commission. One such report indicates, “the average increase in a hospital’s operational costs for a serious fall-related injury is more than $13,000, and the patient’s length of stay increases by an average of 6.27 days.” Each hospital knows their own metrics for cost of falls, however, the point is that this money could easily be used to improve other areas of the hospital, such as onboarding surgical talent or improving technology.
For years, leadership has been narrowly focused on HAI and fall prevention. Because of this focus, the industry has experienced consistent improvements and adjustments to the standards being implemented by the Joint Commission and the CDC. To keep up with the pressing need to improve, standards set out by these organizations and new tools and technologies are innovating how we look at resolving issues forcing change in hospitals. Unfortunately, this may not be a welcomed change because of the high level of risk involved in adopting these new tools.
Think of the healthcare industry like a piece of raw lumber with some small imperfections—dents, scratches, holes and natural grain. To turn that piece of lumber into a fine piece of furniture, you would need hours of sanding and filling the imperfections, priming, painting and polishing. Likewise, integrating technology that corresponds with patient safety initiatives ‘fills in the gaps’ where humans may have a hard time keeping up—checking the patient’s electronic health record (EHR) for core measures, confirming that the bed is in the safest position for the patient, ensuring there is adequate staff to keep track of each patient’s individual needs, and the list goes on.
One study shows that distraction is responsible for nearly 60% of medication errors and over 27% of procedure, treatment or test errors.
The human element is something to consider as well. If a nurse were able to tick things off of a to-do list, there would fewer issues. Unfortunately, not every patient fits the same mold, so standardized to-do lists don’t always suit each patient’s need. Nurse error leads to many sentinel events, with most errors caused predominantly by distraction. One study shows that distraction is responsible for nearly 60% of medication errors and over 27% of procedure, treatment or test errors.
“For each interruption, there was a 12.1% increase in procedural failures and a 12.7% increase in clinical errors, with the association between interruptions and clinical errors independent of hospital and nurse characteristics.”
In the article “Interruptions Linked to Medication Errors by Nurses,” errors were measured when nurses experienced interruptions. The study showed that “(f)or each interruption, there was a 12.1% increase in procedural failures and a 12.7% increase in clinical errors, with the association between interruptions and clinical errors independent of hospital and nurse characteristics.” In fact, the research found that nurses’ experience in the field and knowledge had nothing to do with the mistakes. The nurses in the study were fully trained and certified to carry out all of the safety measures studied and they still made errors. The article continues to say, “(n)urse experience did not protect against clinical errors and was actually associated with a higher rate of procedural failure. The frequency of the interruptions was associated with increased severity of the error. The estimated risk for a major error was 2.3% when there were no interruptions, versus 4.7% when there were four interruptions (95% CI, 2.9% – 7.4%; P<.001).” It is clear that the chances of error more than doubled when interruptions were introduced to the nursing staff.
Leadership has felt the pressure to pursue methodologies and technologies to fill in these inherent gaps, similar to the example of the furniture. Higher quality work yields a more valuable piece of furniture.
LEAN Methodologies allow organizations to make incremental improvements across multiple domains within their industry, without interrupting the workflow of too many individuals. By making small changes and measuring and adjusting as needed, LEAN methods can help the healthcare industry improve patient safety in patient rooms. We’ve seen examples of LEAN methodologies in healthcare already—room signage, color-coded socks and wristbands, creating best practices for bed adjustments, purposeful rounding and so forth. How, then, can we implement changes for patient safety that are drastic enough to make the difference demanded from healthcare today? LEAN enables implementation of technology that has the potential for a big impact on the organization. Big changes, however, do not always have a smooth transition and will take time to implement. These enhancements may need to be introduced to the organization in a smaller capacity at first, to ensure proper testing and training. That is where LEAN comes in.
Technology continues to improve at an incredible rate. One example of this is the EHR. The EHR of today is not the same EHR used five or ten years ago. Its implementation was not a smooth process, and many physicians and hospital administrators rejected the electronic solution at first, but today it is the standard. EHRs have been influential in keeping up with safety standards and core measures. If a diagnosis is determined or a treatment is ordered, the EHR can remind the care team that action is needed. EHR systems have also become a platform for other smart technologies.
Infusion pumps have gotten smart. They can compare the nurse’s entered dosage with the ordered dose in the EHR and warn the care team if there is dissonance, preventing adverse events occurring from medication overdose.
Telemetry has gotten smart. They can run the patient’s vitals through algorithms that predict sentinel events—some up to six hours in advance of the event—preventing cardiac complications, anticipating fall risks and improving patient safety.
Beds have gotten smart. Beds today have sensors everywhere—rail sensors, height sensors, angle sensors, weight sensors and more. The bed can then be set up to communicate via alarms and lights according to the rules set up for the bed. They can also be wirelessly connected to the nurse call system, so care team members no longer need to plug them in.
Dry-erase boards have gotten smart. Electronic whiteboards in patient rooms can connect to the hospital’s existing platforms, including the EHR, smart bed, nurse call and assignment systems to enhance the coordination of patient care and to introduce a patient safety dashboard type workflow. If a patient is at a high risk for falls, algorithms in the electronic patient room whiteboard will compare that information from the EHR with the settings on the bed and notify patients and their family if there is a safety conflict via visual alerts on the whiteboard display. By displaying the patient’s mobility in a clear and easy‐to‐read way, the patient and their family will know what the patient should and should not be doing, dramatically decreasing the patient’s risk of falls. A patient with core measures that need to be met can have an alert displayed on the whiteboard, outside the room on a door display and at the nurses’ station.
With all of these technologies connected in the continuum of care, the patient room can become a safe haven. However, it may not be realistic for the hospital to take on all of these technologies at once. By using LEAN methodology to introduce the technology, hospitals can set up test units measuring small deployments incrementally, then use evidence-based metrics to drive decisions for expansion.
Patient safety is just one of the many things that hospital leadership has to contend with. Multitasking and interruption is plaguing healthcare professionals every day. Implementation of innovative technologies, patient rooms and patient safety can be drastically improved upon.
MEDI+SIGN provides hospital and healthcare organizations with a connected health platform that includes patient monitoring and digital whiteboard display solutions. MEDI+SIGN integrates with electronic health records and remote monitoring systems to collect and communicate updated and accurate patient health and status information to care teams.
To learn more about MEDI+SIGN electronic whiteboard solutions for the patient room, patient door and the nurses’ station, and to see how it will help improve the safety of your patients, visit www.medisigndisplays.com.
- 22nd National Forum on Quality Improvement in Health Care: December 5-8, 2010 Saddleback Memorial Memorialcare Health System
- Studies in Patient Safety – Pennsylvania Medical Society