‘We have a long way to go yet on pa­tient safety’

Modern Healthcare - - Q & A -

As pres­i­dent and CEO of the Na­tional Pa­tient Safety Foun­da­tion, Dr. Te­jal Gandhi tack­les is­sues such as di­ag­nos­tic er­rors and un­in­tended harm from elec­tronic health records. Mod­ern Health­care qual­ity and safety re­porter Sabriya Rice re­cently spoke with Gandhi about th­ese and other con­cerns of the pa­tient safety move­ment. The fol­low­ing is an edited tran­script.

Mod­ern Health­care: What do you see as the area of most con­cern to pa­tient safety ad­vo­cates to­day?

Dr. Te­jal Gandhi: I worry about com­pla­cency. We have been work­ing on pa­tient safety for over 15 years, and of­ten there are new pri­or­i­ties that come around like pop­u­la­tion health or cost re­duc­tion. We have a long way to go yet on pa­tient safety.

MH: Is your pa­tient safety work shift­ing from in­pa­tient to out­pa­tient set­tings?

Gandhi: Ex­pand­ing our work to set­tings out­side of hos­pi­tals is crit­i­cally im­por­tant. Most care is given out­side of hos­pi­tals. It makes sense that we started in hos­pi­tals where there’s high acu­ity and lots of risk. There are sig­nif­i­cant safety is­sues that can hap­pen in pri­mary-care set­tings, in nurs­ing homes and in home care.

What it’s go­ing to take is a bet­ter aware­ness of what those is­sues are and more lead­er­ship fo­cus on th­ese set­tings.

The third thing we need to do is de­velop some in­fras­truc­ture, be­cause am­bu­la­tory set­tings of­ten don’t have the qual­ity and safety in­fra­struc­tures of hos­pi­tals.

MH: How are elec­tronic health records in hospi­tal set­tings hav­ing an im­pact on pa­tient safety?

Gandhi: The po­ten­tial for en­hanc­ing qual­ity and safety through those records is large. The chal­lenge, though, is that of­ten the tech­nolo­gies are not well-in­te­grated into work­flows so are maybe not achiev­ing those qual­ity and safety ben­e­fits.

They are cre­at­ing some new un­in­tended harms as well. We re­ally need to fig­ure out how to op­ti­mize th­ese tech­nolo­gies to make sure that they’re re­ally im­prov­ing qual­ity and safety, while not cre­at­ing new un­in­tended con­se­quences.

MH: How do you make that hap­pen?

Gandhi: One way to im­prove co­or­di­na­tion is with bet­ter in­ter­op­er­abil­ity and more abil­ity to com­mu­ni­cate in­for­ma­tion across the care con­tin­uum. A lot of or­ga­ni­za­tions have been do­ing in­no­va­tive things to help make th­ese tran­si­tions of care across var­i­ous set­tings more ef­fec­tive, such as hav­ing more per­son-to-per­son com­mu­ni­ca­tions as op­posed to just re­ly­ing on pa­per­work; mak­ing sure pa­tients have fol­low-up ap­point­ments and fol­lowup phone calls when they’re in those tran­si­tion mo­ments; even hav­ing case man­agers to fol­low pa­tients along all those stops on the con­tin­uum to make sure care is co­or­di­nated.

MH: Do you think that pa­tients are in­volved enough now?

Gandhi: We can do a lot more in terms of com­mu­ni­cat­ing with pa­tients about care plans and about risks and ben­e­fits of var­i­ous treat­ment op­tions. We’ve done a lot of work about com­mu­ni­cat­ing bet­ter when er­rors hap­pen and when harm hap­pens, and be­ing much more up­front and truth­ful about those things. But also we can do a lot bet­ter with en­gag­ing pa­tients in im­prove­ment work (by) ask­ing pa­tients about is­sues that are com­ing up and then in­volv­ing them in the so­lu­tions. We of­ten cre­ate the im­prove­ments with­out the pa­tient voice at the ta­ble.

MH: You were re­cently on a Na­tional Academies of Sciences, Engi­neer­ing and Medicine com­mit­tee fo­cused on di­ag­nos­tic er­rors. How big of a chal­lenge is that is­sue?

“We need a cul­ture change where clin­i­cians are much more com­fort­able talk­ing about di­ag­nos­tic er­rors.”

Gandhi: It’s a newer area that we’re re­ally try­ing to fo­cus on. We need a cul­ture change where clin­i­cians are much more com­fort­able talk­ing about di­ag­nos­tic er­rors and get­ting feed­back.

I think about them in terms of core sys­tems that need to get bet­ter, like how we man­age test re­sults and how we man­age re­fer­rals. But then also there’s a re­ally chal­leng­ing area around cog­ni­tive er­ror. Er­rors will hap­pen, hu­man be­ings will make cog­ni­tive er­rors. But how do you build a sys­tem that will, hope­fully, catch those be­fore too much time goes by and a di­ag­no­sis gets very de­layed? There will be a lot of work over the next decade try­ing to un­der­stand the causes of cog­ni­tive er­ror and what in­ter­ven­tions will hope­fully mit­i­gate some of those er­rors.

MH: How do you iden­tify your own bi­ases as a clin­i­cian?

Gandhi: A lot of those bi­ases help us make re­ally good rapid di­ag­noses. So they work for us a lot of the time. But then 10% of the time they might lead you astray. There’s a lot of dis­cus­sion about how do we do bet­ter ed­u­ca­tion and train­ing for clin­i­cians so they are more self-aware of their cog­ni­tive bi­ases, po­ten­tially through things like sim­u­la­tion, for ex­am­ple.

That kind of train­ing and ed­u­ca­tion is nec­es­sary but not suf­fi­cient be­cause no mat­ter what, in a busy, har­ried day where there are in­ter­rup­tions and dis­trac­tions, hu­man be­ings will make mis­takes. So we have to build that sup­port­ive sys­tem around ed­u­ca­tion and train­ing so that if that er­ror still hap­pens, we can catch it early.

MH: You re­cently formed a work group on the copy-and-paste prob­lem. What is that and how does it cause pa­tient safety is­sues?

Gandhi: One of the un­in­tended con­se­quences of health in­for­ma­tion tech­nol­ogy is copy and paste. Be­fore, we would hand­write our notes. Of­ten they were un­in­tel­li­gi­ble and hard to find. The idea was the com­puter was go­ing to make notes leg­i­ble. In a lot of ways, it has im­proved time­li­ness and the abil­ity to find notes.

From an ef­fi­ciency stand­point, copy­ing and past­ing in­for­ma­tion can help you write your notes faster. But of­ten peo­ple are do­ing too much copy­ing and past­ing.

Ven­dors, providers, in­sur­ers, safety ex­perts, and re­searchers are try­ing to tackle some of th­ese new un­in­tended con­se­quences of health in­for­ma­tion tech­nol­ogy. Our work group on copy and paste had all of those voices at the ta­ble and we de­vel­oped a tool kit that would give rec­om­men­da­tions to ven­dors about how they might de­sign their sys­tems to make it eas­ier to know what’s been copied and pasted.

We also made rec­om­men­da­tions for health sys­tems about how they might train and ed­u­cate their clin­i­cians about the use of copy and paste. Are they us­ing it ef­fec­tively ver­sus in­ef­fec­tively? Ev­ery hospi­tal around the country is in­di­vid­u­ally try­ing to solve this is­sue, and I think there’s a real value of say­ing at the na­tional level here are some best prac­tices so ev­ery hospi­tal doesn’t have to try to tackle it in­de­pen­dently.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.