Closing The Gap: How Health IT Will Impact PMEs At Shift Change

By Decisio Health

Patients seek medical care to improve their health. Yet, after checking into a hospital, some patients become more ill — or even die — due to preventable medical errors (PMEs). In the new era of value-based reimbursement, and as preventable medical errors have risen to the third leading cause of death in the United States, healthcare facilities are now tasked with implementing innovative strategies in order to improve patient hand-off communication and generate positive patient outcomes.

A caregiver cannot provide care 24 hours a day, seven days a week. Clinicians change shifts every eight to 12 hours and multiple practitioners will be responsible for a patient’s care throughout the day. Crucial patient information is shared during the transfer of care including diagnosis, vitals, outstanding medication, tests or procedures. it’s possible — even likely — critical information may be missed during the handoff.

Studies have shown multiple handoffs of care, including transitions from one unit to another, create a discontinuity among hospital staff that can lead to adverse events in a patient’s care. One such study found when a PME was reported, the patient was more than twice as likely to be covered by a physician from another team at the time of the event. In another, communication errors, particularly during shift change, were found to be a factor in 30 percent of malpractice cases which resulted in 1,744 deaths.

Why are shift changes so hazardous?

For starters, change of shift reporting is often completed well before the actual hand-off. Hence, a change in the patient’s condition during the lag time would not be reflected in the report. Another issue lies in the common practice of utilizing manually entered sign-out sheets for communication between physicians. One study found errors in 67 percent of the sheets, including missing allergy and weight and incorrect medication information.

Still, the trouble goes beyond inaccurate and out of date reporting. Marie-Elena Barry, MSN, RN writes in an American Nurse Today article that on top of reporting of lengthy and irrelevant patient statistics and poor recall of patient information, nurse fatigue, work time constraints, and frequent interruptions by the patient or other members of the healthcare team are all contributing factors to errors during shift change.

Navigating cumbersome EHRs and sourcing vital patient information located in disparate systems adds another layer of challenges. A recent survey by Health Affairs reported physicians and staff spent 15.1 hours per physician each week tracking, developing, and implementing data collection processes, entering information, or transmitting data. Some physicians are even finding portions of vital information are buried within the EHR’s progress notes or parts of the physician narrative, like the patient history, and therefore are not easily accessible.

One survey of 1,515 residents and fellows, as published in the Journal of Graduate Medical Education in December 2013, noted an overwhelming 92 percent of respondents agreed clinical documentation requirements have become excessive, with 73 percent indicating overall patient care was being negatively affected by the burden.

Yet, despite the inherent challenges, improving communication is essential in the newly established value-based reimbursement model, where patient satisfaction and positive patient outcomes will now have a direct impact on the provider’s bottom line. In fact, there may be a direct link between Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores and profitability.

When examining data from 3,035 acute-care hospitals, 25 percent of hospitals with the highest HCAHPS scores were also the most profitable with a mean margin of .93, with the hospitals scoring lower for patient satisfaction showing significantly lower profitability.

Is better health technology the answer?

It might be. Experts agree in order to improve the transfer of patient information, healthcare facilities must make innovative strategies that make the quality of hand-off communication a priority. As stated in a report published by Solet DJ et al., many deadly miscommunications could be corrected by introducing a standardized method for patient handoffs.

“We suggest institutions develop such handoff packages as part of their information technology infrastructure,” the doctors write. This may include software packages or clinical decision support tools, such as intelligence platforms that limit avoidable interruptions and distraction, while providing a holistic view of the overall patient condition. The implementation of bedside dashboards that provide a glimpse of a patient’s vital signs at any given moment will mean each clinician charged with responsibility for the patient’s care will have access to vitals and trends in one easy-to-view location.

In fact, mounting evidence suggests these types of clinical decision support tools, when used effectively, can improve healthcare quality and safety. One study revealed nurses are interrupted almost 12 times per hour making management of distractions and effective communication critical in care settings. Because patient vital signs and trends are captured in one easy-to-view location within a clinical intelligence platform, clinicians are able to spend less time searching for answers in an EHR and more time communicating with colleagues during potentially hazardous procedures, such as the shift change.

There may be an added benefit of conducting shift-change reporting via a dashboard located at the patient’s bedside. Some research has supported the use of bedside shift reports to facilitate physician-patient communication. This way, the patient is able to play an active role in the shift change and reporting process, assisting the clinician as he or she goes over the report and checks for misinformation. Conducting the reporting in such proximity to the patient, one study suggests, actually increased patient satisfaction.

While some level of human error is inevitable, it is possible and ­vitally necessary to reduce the instance of PMEs. In this new era of value-based care, it’s likely we will see a marked increase in health IT spending in the coming months in order to implement technologies to optimize the transfer of knowledge at the patient bedside and ultimately make the clinician communication and shift-change process easier.