Quality & Patient Safety

Survey: IT executives list patient safety as top concern
CMS seeks input on patient experience survey
Excessive workload, communication problems factor largely in ICU mistakes

Patient Safety Monitor Alert, February 13, 2003

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SURVEY: IT EXECUTIVES LIST PATIENT SAFETY AS TOP CONCERN

Chances are, your information technology (IT) department has patient safety issues at heart. In fact, it probably cares more about patient safety technology than about implementing Health Insurance Portability and Accountability Act of 1996 (HIPAA) technology.

According to the 14th Annual Health Information Management Systems Society (HIMSS) Leadership Survey, concerns about implementing technology to reduce medical errors and promote patient safety surpassed HIPAA technology issues as the top priority for the facilities of more than half of the IT executives. While 52 percent cited patient safety as a current top concern, 59 percent said it would be a priority in the next two years. Sixty-three percent of IT executives agreed that patient safety is one of the five business issues that will affect health care the most in the next two years.

The respondents said that the following three applications would be most important to their facilities over the next two years:
- Computer-based physician order entry
- Clinical information systems
- Bar coded medication management

Respondents' priorities correlate with 2004 budgets proposed by the Department of Health and Human Services and the Centers for Medicare and Medicaid Services, which set aside significant funds for patient safety initiatives and HIPAA enforcement, among other initiatives, said Charles O. Bracken, Executive Vice president of Superior Consultant Company. The Food and Drug Administration also recently announced that President Bush's budget request includes $4 million for the FDA's new patient safety initiative to decrease adverse events involving drugs and devices, as well as $5 million to expand its joint effort with the National Institute of Health (which requested $25 million) to ensure medicines have been properly evaluated for use in pediatric populations.

CMS SEEKS INPUT ON PATIENT EXPERIENCE SURVEY

What should The Centers for Medicare and Medicaid (CMS) officials ask patients about their stay at your hospital? Here's your chance to let the government agency know what you think.

CMS has released a draft copy of its "Hospital CAHPS CMS Pilot Test Questionnaire" and last week published a request for comments in the Federal Register. The survey, based on the CAHPS survey designed for managed care institutions, is designed to provide comparison information to consumers, "and as a way of encouraging accountability of hospitals for the care they provide," according to the Federal Register. CMS plans to pilot the survey in Arizona, Maryland, and New York hospitals beginning in early March.

Specifically, the organization would like feedback on issues such as how to make the information it plans to collect more useful, as well as ideas for minimizing the information collection burden through automated means.

The comment period for the pilot will end February 20th. Fax your comments to 410/786-3064, ATTN: Julie Brown. For a copy of the draft questionnaire, please send an e-mail to bbeaupain@hcpro.com with "H-CAHPS" in the subject line.

EXCESSIVE WORKLOAD, COMMUNICATION PROBLEMS FACTOR LARGELY IN ICU MISTAKES

Most mistakes in the intensive care unit (ICU) stem from excessive workload and communication problems, according to a new reporting system. Teams involved in the Intensive Care Unit Safety Reporting System (ICUSRS) met for the first time in late January to discuss the first 350 incidents reported. About 10 percent of the incidents reported led to patient harm, according to a press release from the Society of Critical Care Medicine.

Since ICU caregivers are often reluctant to acknowledge that they need help, one hospital requested that staff wear colored badges to indicate how much work they have. (A red badge means a clinician is overloaded, yellow indicates he or she has an average workload, and green means he or she can take more on.) ICU leaders help members with red badges obtain resources and redistribute their work.

"To improve safety, we need to change the culture in the ICUs," said Peter Pronovost, MD, PhD, the lead investigator of ICUSRS, in the press release. "Simply participating in the project has increased awareness about the problem of patient safety and helped caregivers focus on what is broken rather than who to blame."

The Society for Critical Care Medicine and a team of investigators from Johns Hopkins began ICUSRS in late 2002--it's funded by the Agency for Healthcare Research and Quality. It is the only reporting system for ICUs, according to the release, and though only 15 ICUs currently use it, leaders hope to expand the program nationwide.



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