How can some of the biggest patient safety concerns in healthcare be remedied?

As hospitals face increased liability concerns under Obamacare, a new report highlighting patient safety concerns could help them better prioritize risks to patient care. Data entry errors for electronic health records and care coordination when patients are discharged top the list of patient safety concerns in a new annual report by the ECRI Institute. Some of these issues could be of interest to healthcare startups. Here are some of the problems outlined in the report along with some of the recommendations from ECRI.

Data integrity problems with healthcare IT

Problem:  Data entry errors, missing data or delayed data delivery, copying and pasting older information into a new report, using both paper and electronic systems for patient care

Response: Evaluate the clinical workflow so that the needs of staff who will use these systems can be addressed. Allow enough time for testing the system in a simulated setting before it goes live so problems can be detected early. Train staff in plenty of time. Set up a system for reporting problems and fixing them.

Poor care coordination at discharge

Problem: Healthcare facilities are having trouble ensuring that critical follow-up care instructions are delivered to patients’ primary care providers. “We’re seeing more opportunities for missed information transfer, errors in information, errors in orders when patients are transferred to the post-acute care setting,” observed Lorraine Possanza, patient safety, risk, and quality analyst at ECRI Institute. In one case illustrating the scale of the problem, the abnormal findings on an infant’s CT scan when he was in the hospital for a life threatening event triggered a recommendation for an MRI. But that recommendation wasn’t sent to the patient’s primary care physician and the infant died of sudden infant death syndrome.

Response: Establish procedures that address accessing, reviewing and acting on the findings in the EHR so the data isn’t lost. Ensure contact details for providers listed in EMR are up to date. Do a better job of coordinating care between hospitals and post acute care facilities. One example could involve having pre-admission nurses from the post-acute care setting evaluate patients before discharge to better assess patients’ needs.

Test results reporting errors

Problem: Either the provider that ordered the lab tests doesn’t receive the results or there’s a delay. This problem accounts for 10 percent of the 2,420 events cited in the patient safety report. The top three causes include a poor technology interface between the EHR system and the lab, staffing and training failures and a lack of a safety net in case one provider isn’t available to receive the test results.

Response: Among some of the things providers need to do is vet their system for receiving test results and transmitting that information to patients. They need to establish what is the expected time frame for providers to review results and determine how the findings are given to the patient.

Patient violence in acute care settings

Problem: Hospital staff need to be alert to early warning signs of potential violence when patients with behavioral health needs are treated in emergency or acute care settings.

For healthcare providers not trained in behavioral health, they may not recognize behavioral signals such as shouting, demanding behavior, and physical restlessness and tension, or know how to respond.

Response: There wasn’t much in the report beyond vigilance and training.

Mislabeled lab specimens

Problem: This is the No. 1 lab error issue and is frequently caused by a heavy workload that can cause distraction. These errors are usually caught before the specimens are delivered to the lab, but recollecting them can cause delays in a diagnosis.

Response: Using two patient identifiers such as the patient’s name and date of birth, to properly identify the patient before a specimen is collected. Verifying patient identity with automated technology such as electronic bar-coding systems, can also help match the patients’ specimen to a patient wristband.

Here’s the full list:

1. Data integrity failures with health information technology systems
2. Poor care coordination with patient’s next level of care
3. Test results reporting errors
4. Drug shortages
5. Failure to adequately manage behavioral health patients in acute care settings
6. Mislabeled specimens
7. Retained devices and unretrieved fragments
8. Patient falls while toileting

9. Inadequate monitoring for respiratory depression in patients taking opioids

10. Inadequate reprocessing of endoscopes.

 

[Photo  from Flickr user Picture Perfect Pose]