Ten percent of diagnoses are wrong, delayed, or missed. What can be done to correct this problem and save the 40,000 or more lives that are lost each year as a result? By Melissa Cole, BSN, MSW, FACHE
Ten percent of diagnoses are wrong, delayed, or missed. What can be done to correct this problem and save the 40,000 or more lives that are lost each year as a result?
By Melissa Cole, BSN, MSW, FACHE
March 2nd marked the beginning of the National Patient Safety Foundation’s (NPSF’s) “Patient Safety Awareness Week.” This year’s theme was “Navigate Your Health … Safely.” NPSF cites a patient’s health journey often starts with diagnosis, yet it’s estimated that up to one in every 10 diagnoses is wrong, delayed, or missed completely. Collectively these errors may contribute to 40,000-80,000 deaths per year in the U.S.
Scoping the Continued Urgency
In research for this piece and several speaking engagements, it is evident the data around patient safety concerns appears to be static or climbing. In September 2013, the Journal of Patient Safety reported that between 210,000 and 440,000 patients each year who go to the hospital for care suffer some type of preventable harm that contributes to their death. This makes medical errors the third-leading cause of death in America, behind heart disease and cancer.
Dave deBronkart AKA: @ePatientDave · Feb 23 Tweets:
“#HIMSS14 Okay, here's the source for my "2/3 of medical records contain errors" - not a formal study but consistent: http://dave.pt/1cF5mbh”: Referencing two-thirds of patient data is not accurate upon patient review; allergy, medication or diagnosis information is in need of correcting (much in line with what NPSF is calling to our attention).
The ECRI Institute reports the top 10 health technology hazards each year. EHRs and other healthcare IT systems have been listed due to “data Integrity failures.” The Office of the National Coordinator for Health IT has responded by issuing nine guides to help healthcare organizations assess the safety of EHRs and to use them effectively. Known as the Safety Assurance Factors for EHR Resilience (SAFER) Guides, they offer a suite of tools that include checklists and recommended practices to boost EHR safety.
Seismic Culture Shift
We continue to be in the midst of a seismic culture shift. Healthcare systems, which have been slow to adopt change, or unable to move from ‘this is how we have always done things’ thinking, will suffer. Organizations that have been ‘protecting providers’ by not asking them to make too many clicks are not helping those providers in the long run. I’ve seen healthcare systems on shoestring budgets invest time and resources in the needed workflow analysis, and ensure all of the medications on the formulary are orderable with indications (and robust evidence-based order-sets available). These are the same organizations that are careful to include discrete fields for all core measures and Meaningful Use fields they are able to gather prior to a ‘go live’ event.
Healthcare systems that embrace innovation and are also High Reliability Organizations will thrive moving forward. They typically exhibit workflow changes beyond the scope of current efforts – integrating clinician workflow, clinical best practice and patient centricity. They ensure the patient reviews the chart to be certain the data is up-to-date and correct. This type of collaboration is a huge shift for clinical staff and organizations.
It is also helpful if data management is managed in a horizontal manner across a system. In other words, all data entered is correct and shared across the enterprise, and quality indicators are measured to the same standards. Integration of a data governance plan (foreign to many healthcare organizations), is the foundation to ensure all data is clean and that clinical staff can be assured of the data’s reliability. Clinicians are more likely to change their behavior when given actionable data that they trust and the hurdles are taken out of their way to optimally perform.
Getting It Right
Healthcare systems will be able to leverage their EHRs when the data is clean, and the workflow is efficient and patient-centric. Look to the HIMSS Davies award winners and nominees and what they are doing to get positive results. HIMSS reports that:
“In one year, UC Davis Health System achieved a 44.4 percent decrease in central line bloodstream infections, a 65.9 percent reduction in surgical site infections and an 8.6 percent decrease in catheter associated urinary tract infection. Clinical improvement achievements such as these are the result of active engagement by clinicians and use of the EHR. With the EHR’s capability to drill down into the data, physician leaders receive ‘daily monitored results’ for key clinical goals and are able to respond quickly with communication to physicians and residents when metrics indicate the need to take steps to improve.
“The ability to prevent avoidable readmissions by patients with certain chronic conditions within 30 days of discharge is a primary success factor for hospitals in adhering to forthcoming changes in the reimbursement model used by Medicare. New York-based Mount Sinai Medical Center (MSMC) established an EHR-based process to efficiently and accurately identify patients at high risk. By incorporating the identification process into the design and implementation of the EHR, MSMC has effectively been able to hardwire key workflow processes required to reduce readmissions, improve care and lower the costs of care. A 56 percent reduction in 30-day readmission rates has been realized, and these gains have been sustained at 60 and 90 days of discharge.”
These facilities unfortunately are the exception to the rule right now. Quality, data management and IT systems have been done the same way for years, even decades, in many organizations. Protecting the limited time of providers by keeping clicks to a minimum, among other things, restricts what an organization is to ask of them – especially when it comes to Meaningful Use and bringing a patient into the conversation in a significant way. If we ask providers to see too many patients for them to adequately review charts and perform medication reconciliations, then we must together look to see what is safe practice for all.
Call to Action
The gap between educated patients and providers is closing. Collaboration amongst all stakeholders - providers, patients and staff – is paramount. Successful technology adoption is 95 percent collaboration and people skills, with 5 percent left over for functionality. How do we cross this quality chasm? Data! Providers respond to data – clean data. That is why data governance is so important: It will be the only way for clinical staff to respect the quality of the data, and the only way to attain best-practice results for patient care.
We must challenge ourselves as we navigate our way forward on this journey of patient safety. Each of us brings skills, knowledge and innovation. The way in which we collaborate, communicate and ultimately implement each portion of what we have to offer will determine if our systems thrive or struggle. Organizations with the best collaborations, supportive leadership, and a culture of safety and high reliability will thrive.
About the author
Melissa Cole, BSN, MSW, FACHE, is Quality Consultant at the University of New Mexico Hospitals.