In general, practitioners don’t appreciate anything that “pops up” or gets in the way of their typical workflow. This aspect of some EMRs can cause dissatisfaction, even anger. A good example is warnings related to medication prescribing. In some programs, drug interactions of any severity and their complications litter the screen with overwhelming frequency. This simply becomes white noise and is soon ignored, sometimes to the peril of the patient as well as the practitioner.
In emergency medicine and presumably in urgent and primary care, one of the common failure-to-diagnose drivers is the failure to recognize or act upon abnormal vital signs. In one analysis of 90,000 patients that we published in Annals of Emergency Medicine, 16% of patients presented to the emergency department with an abnormal vital sign, and 10% of that group went home without a single repeat of the abnormal vital sign. That analysis came from over 200 emergency departments across the U.S., representing over 7 million patient visits annually. From a quick calculation, you can see there are a lot of patients with abnormal vital signs being discharged from EDs across the U.S., and there are undoubtedly failure-to-diagnose adverse events and significant morbidity in that patient group.
Electronic Medical Record (EMR) and Electronic Health Record (EHR) systems were developed to satisfy several important needs (I will use EMR and EHR interchangeably). Just to name a few: legible documentation of patient encounters, satisfaction of coding and billing requirements, regulatory compliance, prevention of medication errors, clinical pathway utilization, medical-legal defensibility, and data compilation. Having seen and used several EMR systems, I can tell you that they were not developed with the primary goal of improving user efficiency.
One of our goals at The Sullivan Group is to bring you practical pearls to reduce risk, improve patient safety, and enhance quality in your everyday practice. To that end I thought I would share with you this “alphabet soup” of healthcare risk management and patient safety tips assembled from years of observation and experience.
Our mission at The Sullivan Group is to positively change clinical practice, improve patient safety and reduce malpractice litigation. Because of this, we are often asked by clinical leaders and clients to explore the impact our RSQ® Solutions platform may have on other areas of the healthcare business. A Chief Nursing Officer with whom we have worked for the past several years connected with me at the 19th Annual NPSF Patient Safety Congress in Orlando, FL, with a similar inquiry. She asked if we had any evidence to support a relationship between our work with improving nursing competency/patient safety and nursing retention rates.
There are a number of laws in the various states that prohibit the abuse or exploitation of certain classes of people. The classes of persons who are protected generally include those who are particularly vulnerable to abuse and who may be incapable of defending themselves. The prohibition against child abuse is inherent in virtually all state statutory schemes and is widely known. Less well known, at least outside the long-term care industry, is the prohibition against the abuse or exploitations of the elderly and other vulnerable adults.
The threat of a cyber attack seems only to be increasing in healthcare. Recent reports show security issues include losses by large and small providers. Based on the reports in the media, it would appear that no one is immune to this threat.
Before we look for ways to minimize cyber risk, it's important to understand the state of healthcare cyber liability.
Since we recently laid out an exercise mapping clinical risks to frequent diagnosis-related claims in Emergency Medicine, we're circling back to recommend a risk mitigation exercise for another area of high risk medicine, Obstetrics.
A recent The Doctors Company analysis identified the most frequent obstetric claims as:
Anything and everything that improves patient safety is important. The sheer weight of that sentence can be overwhelming to healthcare professionals. Consider one conclusion from the Institute of Medicine (IOM) report “Improving Diagnosis in Healthcare” that states, “Advancing patient safety requires an overarching shift from reactive, piecemeal interventions to a total systems approach to safety in which safety is systematic and is uniformly applied across the total process.”
Many organizations that study medical liability trends often point to breakdowns in communication, cognitive errors, lapse in clinical judgement, etc. as the main contributing factors that cause diagnosis-related claims. Because 60% of Emergency Medicine claims are diagnosis-related, every health care organization should have a strategy for mapping and organizing the most common clinical risk areas that physician’s face. Below we outline a tool that aims to help health systems organize a strategy to address the most frequent and severe malpractice claims.
