Unquestionably, patient safety has always been a matter of the utmost concern in healthcare. What has changed over the past few years is the degree to which clinical organizations are being scrutinized for their patient safety records, and the public level of demand for improvement. Along with cost, efficiency and availability, patient safety has become one of the key issues in healthcare today.
Let’s face it; living in a fishbowl is not fun. This is only going to get worse. New patient safety oversight organizations are cropping up continuously. And the ones with the greatest clout are voicing their disappointment and outrage over clinical failures more loudly than ever, as well as pointing fingers directly at you. While consumers are becoming better informed payers, employers and governmental agencies related to healthcare are becoming more sophisticated in their analysis.
Everybody wants action. Now. From you.
We believe business intelligence can help. You can use your data to better defend yourself. But more importantly, you can use that same data to proactively improve your processes and decisions, leading to improved patient safety. But your data needs to be clean, focused, organized and accessible to the right people, or it will become just another troublesome pile of work for you and your organization to deal with.
The Nature of Patient Safety and Patient Safety Data
Three facts must be kept in mind when discussing patient safety and patient safety data. These are:
•Nature. People are going to get hurt and die. Every healthcare professional we know has had this realization pounded into their heads throughout their education and into their professional lives.
•Human Nature. Human beings view the standard in healthcare safety as absolute, total perfection. Therefore, we naturally understand patient safety in negative terms (i.e., deviations from perfection). The stakes are too high to do otherwise. It would be reprehensible to say a certain level of failure is acceptable. It is not.
•Nature of Patient Safety Data. Safety statistics are naturally negative and data is hard to obtain. Any numbers that are reported are viewed as criticism of the person, the process and the organization. Understanding this data is critical to improvement, but difficult to obtain reliably and consistently due to the natural reluctance to admit failure.
Nobody can install a system that will solve these problems. But you can use systems to develop a base of evidence to support continuous improvement efforts. This will help to prevent as many patient safety problems as possible. That is what business intelligence is all about.
Patient Safety Numbers
That said, our starting point is to look at the numbers. A widely publicized figure is medical error death, claiming as many as 98,000 lives each year. This is one of a broader category of unnecessary death that the healthcare field refers to as “iatrogenic death.” The top medical errors causing iatrogenic deaths in the United States are:
2.Nosocomial infections (hospital-acquired infections);
3.Medical device defects;
4.Human errors in using medical devices; and
Experts must estimate these numbers, since precise data is difficult to collect. This statistic does not include medication administration errors, which add another 7,000 deaths to the total. According to the HealthGrades Second Annual Patient Safety in American Hospitals Report (May 2005), hospital-acquired infections worsened by approximately 20 percent from 2000 to 2003 and accounted for 9,552 deaths and $2.6 billion, almost 30 percent of the total excess cost related to patient safety incidents.
The most commonly reported causes for medical errors are:
•Environmental factors (noise, lighting, disruption);
•Overworked staff (forced overtime due to shortages);
•Poor communication between patient and providers;
•Mislabeled medication and equipment;
•Improper or lack of hand-washing;
•Systematic errors/clerical errors; and
•Slow or no access to medical records.
To make matters worse, some of the leading healthcare organizations that tally errors and work with doctors and hospitals to improve quality say that healthcare providers routinely underreport their errors and mistakes, probably most often due to liability concerns. Such low reporting contributes to medical errors making it difficult to find solutions to the problems that created the errors in the first place.
Business Intelligence Can Help
To illustrate the various ways business intelligence can help improve patient safety, here is one example—controlling nosocomial or hospital-acquired infections. This example is both a composite of numerous interviews with healthcare professionals as well as our own past experiences working with infection-control information.
In the past several years, hospitals have made great strides in their efforts to prevent nosocomial, or hospital-acquired infections. Yet, according to the Center for Disease Control (CDC), about 5 to 10 percent of patients admitted to hospitals in the United States became infected. While many nosocomial infections are simply unavoidable, it is estimated that about 25 percent of these infections could be prevented by healthcare workers taking proper precautions while caring for patients.
Infection Control Practitioners (ICPs) generally have all inpatient lab results sent directly to them for review, which makes it relatively easy to identify most patients with a possible nosocomial infection (not all positive culture results are due to hospital-acquired infection). However, cultures are not always done on every patient with an infection, which makes that group of people particularly hard to identify.
For example, we were monitoring hip-replacement patients for post-surgical site infections. One of the limitations in our data meant we could only view patient census information by the service or unit to which they were admitted. The culture result reports received from the lab also had the unit identified, but not every patient admitted to the orthopedic unit was there for a hip replacement. There was no way to obtain a list of hip-replacement surgeries by patient. Conversely, when the orthopedic unit was full, a hip-replacement patient could be boarded on another unit. Therefore, we never had a high degree of confidence that we had identified all of the patients in our focus group. This meant our report data could not be deemed reliable.
Identifying patient populations for infection control surveillance could be done using business intelligence, especially with a patient data registry. Instead of relying on a patient’s physical location within the hospital as a starting point for your investigation, you could retrieve the exact data from the patient registry. Additionally, it would be possible to slice, dice, sort and sum populations by date time, provider, location, etc. This allows you to identify which patients came into the hospital with an infection vs. which patients may truly have a nosocomial infection.
The Bigger Picture
Due to the volume of patients in larger hospitals, many Infection Control departments do not have the time or resources to monitor every patient for nosocomial infections. Oftentimes, they will monitor certain targeted groups centered on procedures, medical equipment or even certain doctors or staff in the hospital that might be carriers of such pathogens. Using clean, accurate and complete data that is organized for heavy duty analysis, it could be feasible to monitor all inpatients, identify causes of infection and even point toward preventative actions.
Do not let the word “business” in business intelligence get in the way of using business intelligence’s potential in other forms of intelligence and surveillance. Business intelligence opens up many doors in the world of Infection Control Surveillance, for example. Hospitals would also be able to quickly identify trends and patterns in infections, and zone in on the sources of the “roughly 25 percent” of nosocomial infections that are avoidable. This would lead to a better understanding of how to prevent and reduce the costs associated with nosocomial infections.
While we can measure medical errors and their causes, we cannot make correlations between the causes and effects without solid evidence. Business intelligence enables us to understand the correlations between the metrics and delineates the cause-and-effect relationships among the metrics.
Currently, few healthcare organizations research outcome and process improvement strategies mainly because it is not easy to do. Moreover, leaders are hesitant to walk into the fire for fear of what they might find. However, this is an opportunity for you to get ahead of the curve. With President George W. Bush’s current initiatives on improving quality and patient safety, all healthcare facilities will eventually have to comply. If not, they will face consequences and pressure from governing organizations.
With business intelligence you will not have to simply cross your fingers and hope that your decisions and solutions will be correct. Your decisions will be right because they will be supported by your own data from your hospital or healthcare facility. By using business intelligence to drive decision making, you will decrease the variation in healthcare delivery and thereby reduce costs and errors.
Donald Berwick, M.D., and CEO of the Institute for Healthcare Improvement, on the concern about rising healthcare costs said, “One (strategy) is to cut cost, but that will lead to shortcuts that may harm patient safety. The smart way to cut costs is to improve safety and quality.”
The potential value of business intelligence in improving patient safety is tremendous. Business intelligence practices, processes and technologies are similar in many respects to those used in surveillance systems. The first step is to determine which patient safety areas might be improved by using business intelligence capabilities. Once these are identified, one can determine a strategy to incorporate these powerful resources in the patient safety effort.
Thanks for reading. We look forward to your comments.