Guest Column | October 7, 2019

How IT Can Support Patient Safety In A Surgical Setting

By Maura Cash, RN, HST Pathways


Twenty years ago, the Institute of Medicine published its seminal Consensus Report on patient safety, “To Err Is Human: Building a Safer Health System.” That report noted that almost 100,000 annual deaths resulted from preventable medical errors and called for greater exploration of technology to reduce medical errors.

While the medical community has taken this report seriously in the past two decades, healthcare leaders know they must do more. Eighty-nine percent (89 percent) of medical professionals in a recent Health Catalyst survey said they see “room for improvement” in reducing risks. Thirty percent (30 percent) of respondents named “ineffective information technology and the related lack of real-time warnings for possible harm events” as the biggest barrier to this improvement.

Like all healthcare environments, Ambulatory Surgery Centers (ASCs) are also at risk for health IT errors. Surgical suites are already dynamic and fast-paced environments, complicated by patient physiological reactions to invasive procedures and the psychological stress that naturally comes with undergoing an elective procedure. As the volume of procedures performed in ASCs increases (by 2020, about sixty percent (60 percent) of outpatient surgeries are projected to be performed in ASCs – health executives must ensure their health IT’s features are being utilized to support optimal patient outcomes and its ease of use is ensuring clinicians’ focus is on patient care not unnecessary data entry.

Health leaders and software designers/developers should first and foremost seek IT solutions that maximize electronic health record (EHR) interoperability. The Centers for Medicare and Medicaid Services’ (CMS) focus on reducing information siloed to maintain a competitive advantage (or what the Department of Health and Human Services Office of the National Coordinator for Health Information Technology (ONC) refers to as the “trust barriers”) is an important step to prevent medial errors. These barriers block the improvements to patient care pre-operatively and outcomes post-surgery. Although the charting needs and workflow in an ASC can be vastly different from those of physician practices and complex hospital system, ASCs should ensure the software they use features interoperability via common data sets and is fully accessible by other essential health providers for post-operative follow-up.

However, it is not just software interoperability with outside clinical providers and hospitals than can prevent medical errors, but also among users inside the ASC. In an ASC, the chart is approached by all clinicians at once to move the patient through the continuum of care. There is not an orderly progression of events, but rather a simultaneous explosion of questions, answers, orders, and interventions. Knowing what other colleagues have done or discovered in real time is a vital tool to prevent duplication errors and ensure that answers to patient treatment are documented and available to other members of the care team outside of the primary treating clinician.  

An allergy recorded in pre-op should be immediately shown to all clinicians viewing that chart. An alert that a patient has received the maximum allowed dose of a medication should immediately pop up as an alert for the nurse. And the anesthesia provider should be aware well in advance that a patient is claustrophobic. Software designed with the end result in mind — clear, immediate availability of all chart data to all necessary clinicians; timely, appropriate, and significant alerts; secure communication between clinicians; and clinical decision support tools that actually provide assistance not just obligatory documentation requirements — must not just be the goal, but the standard.

The original purpose of the medical record was to provide an accurate reflection of the care received during the patient’s visit. The world of possibilities that software (i.e. artificial intelligence) and hardware (i.e. device interfaces) have to offer is redefining the uses and purpose of medical records for outpatient settings. Using innovations to change the course of patient health outcomes and eliminate avoidable errors will convince the respondents in the Health Catalyst study realize that EHRs and other health technology in the outpatient setting make a meaningful difference and a worthy investment.

About The Author

Maura Cash, RN, is the Director of Clinical Services for HST Pathways, the top-ranked software solutions company for the ASC industry.