Driving down patient harms

BOSTON—A strong focus on patient safety led Adventist Health System to know the most frequent ways it harmed patients by 2009 and launch a system-wide effort to drive down those harms, said Loren Hauck, MD, CMO, speaking at AMIA’s iHealth 2015 Conference.

The focus shifted to measuring patient harm and determining whether patients are safer over time and overall safety interventions have been effective at the Orlando area system.

The effort began with four nurses and two physicians reviewing 20 charts per hospital. Once they knew the most frequent patient harms, they implemented system-wide collaboratives, researched best practices, implemented bundled care and more. The effort focused on harms acquired in the hospital and only acts of commission, not omission, Hauck said. All cases had been closed for at least 60 days so it was truly a retrospective review.

The clinicians reviewed almost 21,000 charts and found that 75 percent had no harm. Of those with harm, 27 percent had more than one hard. Efforts to reduce harm led to a 56 percent reduction over four years.

That wasn’t good enough, he said. They implemented several more tactics aimed to decrease harm even more: evidence-based CPOE enhanced nursing documentation, evidence-based interdisciplinary practice of care, medication bar coding, among others.

“In the first year, 28 percent of patients suffered an adverse event. That’s not an unusual statistic,” said Hauck. But, the executive team was shocked, he noted.

They wanted to know the cost of harm so he began working with the CFO on a DRG-level approach. They published a paper in the Journal of Patient Safety stating that their harm reduction work led to an $18 million improvement in contribution margin and inpatient days by about 60,000.

Patients who experienced serious harm had a higher total cost, higher variable cost, longer LOS by an average of 2.6 days and higher mortality and readmission.

Adventist wanted to stop measuring retrospectively and reduce harm going forward, said Hauck. “That’s the next step in our journey. We’ve moved to a real-time safety management system.”

Risk-trigger monitoring is finding patients dying as a result of their care, not of their disease, he said. There is a high number of harm events that are preventable and costly. “We are capable of measuring and monitoring this clinically confirmed harm at ten times that rate of a voluntary reporting system. The value is present. It’s time for us to act.”