Patient safety: a rallying call for good IT
Many patient safety failures are, at root, information failures. Electronic patient records and other IT investments have a major role to play in improving systems, preventing problems and analysing trends.
International bodies are starting to focus on the issue: so why are so many trusts missing the opportunity to sell the patient safety benefits of new IT to their boards and their staff, asks Jon Hoeksma?
It is an unpalatable fact that the National Health Service inadvertantly harms many of the people it sets out to help. And while “superbugs” like MRSA and Clostridium difficile grab newspaper headlines, many patient care problems stem from information failures.
In the recent, high profile incident at Maidstone and Tunbridge Wells trust, where an outbreak of C. difficile led to 90 deaths between 2004 and 2006, the trust had enough information to identify the problem.
However, the Healthcare Commission noted that “despite the fact that the monthly number of new patients with C. difficile doubled, the trust failed to identify the [first of two] outbreak[s] at the time.”
Indeed, “although the trust was consistently among the 25 per cent of trusts with the highest rates of C. difficile… the board was unaware of the high infection rates and did not spend enough time considering issues relating to infection control.” "Such problems are emphatically not due to bad health professionals, or their managers: instead they mainly stem from system and process failures that arise due to the sheer complexity of modern collaborative healthcare."
At the same time, many of its infection control policies were out of date and not properly communicated to staff (although other factors contributing to the high rate of infection included old buildings, a high turnover of patients and a shortage of nurses).
Failures of information are failures at the heart of healthcare systems
Maidstone and Tunbridge Wells is hardly alone. In many cases, the health service struggles to get the right information in the right place at the right time to support safe and timely patient care.
Whether it’s through prescribing errors, missing patient notes, failure to have the right test results, or giving the wrong blood product, the NHS - along with other modern healthcare systems - regularly harms patients because the right information is not available to the right clinicians at the right time and in the right place.
As well as being a personal tragedy for those concerned and their families, such cases represent a failure of the NHS’ most basic duty to care for patients and avoid doing them any harm. The legal liabilities they create such cases can also add to the legal clinical negligence liabilities the NHS faces – in 2005-6, such clinical negligence litigation cost the NHS £560 million.
IT must underpin complex, modern systems
Such problems are emphatically not due to bad health professionals, or their managers: instead they mainly stem from system and process failures that arise due to the sheer complexity of modern collaborative healthcare.
Put another way, patient harm is due to faulty processes, systems and conditions that lead people to make mistakes or fail to take preventative actions; and to pick up and analyse the data that would tell them when this was happening.
Tangible improvements can be made by moving from paper to electronic records, from focusing on key procesess one at a time, and from putting in place the data warehousing and analysis tools that can alert people to trends and problems. “...at least 44,000” and possibly “as many as 98,000” people “die in hospitals each year as a reult of medical errors that could have been avoided.”
Much good work has already been done in these areas by companies and government agencies and by rolling out IT systems to support e-prescribing, blood tracking and order communications. These are not magic bullets, but they have been shown time and again to be able to deliver measurable benefits to patient safety.
Building a safety culture
Why, then, is IT not being used more systematically, and embraced more enthusiastically, in healthcare? All complex, safety critical industries face similar issues, but some have proved far more effective at dealing with them than healthcare has been so far.
Most famously, the airline industry has adopted a systems engineering approach – in which failures are systematically collected, analysed and learned from.
In doing so, it has managed to make an inherantly risky activity – taking off, flying and landing in a pressurised metal tube strapped to thousands of gallons of high octane fuel – one of the safest forms of transport. Much patient care is considerably less complex than the logistics and enginerring challenges of an airline.
Facing up to the problem
A key step to beginning to adopt such a safety first ethos is to understand the problem you are trying to address, and the figures are truly alarming. If the public knew them, how many would avoid hospitals like the plague?
The most often cited research is the US National Institute of Health’s 1999 report, To Err is Human, which said “at least 44,000” and possibly “as many as 98,000” people “die in hospitals each year as a reult of medical errors that could have been avoided”. Extrapolated to the NHS, these figures would equate to at least 10,000 avoidable deaths per year. "NHS Connecting for Health has undertaken some important safety initiatives, such as adopting the GS1 standard for all forms of device and patient tracking technologies, and working with Microsoft on the Common User Interface project."
The landmark report says that in part the problems are due to the fragmented nature of healthcare delivery and says improved information technology holds part of the answer to reducing such avoidable errors. Above all it says that systemic improvements in patient safety require a patient safety culture.
International action
The importance of a patient safety culture, and of IT to supporting one, is now being recognised at a high level. The European Commission, for example, is now pushing patient safety as the clarion call for investment in health IT.
The World Health Organisation has also been pushing patient safety efforts under its ‘High 5 Project’. At the end of October 2007, health leaders from Germany, the Netherlands, New Zealand, the United Kingdom, Canada and the United States signed a letter of intent to support patient safety efforts.
The high five initiative focuses on:
• Promoting effective management of concentrated injectable medicines
• Assuring medication accuracy at transitions in care
• Improving communications during patient care handovers
• Assuring performance of the correct procedure at the correct body site
• Promoting improved hand hygiene to prevent healthcare-associated infections
In the UK, the chief medical officer, Sir Liam Donaldson, has often made comparisons between the health and airline industries, and sought to learn from the latter.
NHS Connecting for Health has undertaken some important safety initiatives, such as adopting the GS1 standard for all forms of device and patient tracking technologies, and working with Microsoft on the Common User Interface project.
A rallying cry for IT in the NHS
Whatever other pressures healthcare providers and senior managers routinely face, patient safety should be at the core of everything they do.
Improving safety through better information systems offers NHS trusts possibly the best way imaginable to fire clinicians’ enthusiasm in engaging with the clinical systems that are now starting to be delivered under the NHS IT programme and the applications they are deploying themselves.
National politicians may be reticent about using patient safety as the call to arms on IT-supported improvement of clinical processes, but local NHS trusts could achieve much by beginning to use it as a rallying call locally.
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About the author: Jon Hoeksma is technology journalist of the year, and co-founder and editor of the industry portal, E-Health insider.
Tags: care, Clostridium difficile, column, common User Interface, CUI, data, electronic records, European Commission, Jon hoeksma, MRSA, NHS CFH, patient safety, process, World Health Organisation