Patient Safety In Real-time: Why Now and How to Get There
The Problem of Harm 15 Years Later: Still Pervasive But Now Viable Solution Available
In the article, “Measuring Patient Safety in Real Time: An Essential Method for Effectively Improving the Safety of Care,” recently published in the Annals of Internal Medicine by Dr. David Classen, Fran Griffin, and Dr. Donald Berwick, the co-authors strongly advocate to using real time EHR triggers to measure and improve patient safety. Why have these global experts weighed in now?
First, widespread preventable injury to hospitalized patients persists more than 15 years after the IOM report, “To Err is Human,” brought it to international attention. In fact, medical error was recently cited as the third leading cause of death in U.S. hospitalized patients. This magnitude of harm will likely remain unchanged until it is measured effectively and consistently by every hospital, as many have called for.
Second, several leading health care organizations have demonstrated the ability to measure all causes of harm in real time in the whole inpatient population, allowing for more robust measurement and actionable intervention to reduce or mitigate harm. Real-time clinical surveillance not only provides a full-hospital population approach to patient safety but also can help to predict which patients might experience harm and when, supporting prevention before harm occurs:
“Surveillance for harm in the electronic record using the leading commercial EHR vendors’ products can be affordable, sustainable, and actionable….Building on what has been learned from the use of triggers in the past 15 years and leveraging the EHR is a reliable approach to measuring all causes of harm in all hospitalized patients, with minimal resources and in a time frame that allows for concurrent mitigation and prevention.”
Third, the U.S. regulators announced their intent to develop a new electronic hospital safety measure using EHR data. This is expected to replace the current coding/claims based PSI-90, which is tied to reimbursement by both public and private payors. Hospitals are well advised to start preparing now for a significant change in safety- and quality-related payments.