Setting Priorities: The Best Way

Prior to the pandemic, Pascal published a “Top 10” list of patient harms based on clinically validated adverse event outcomes using EHR data (AE Outcomes). Measuring patient-specific AE Outcomes and knowing how a delivery system’s own patients are getting harmed is superior to following the initiative-of-the-day/year from national accreditation bodies or other third parties.

Therefore, in order to manage and reduce preventable patient harm across all adverse event types all the time and for all patients, measuring AE Outcomes is the best first step and using that data for intervention and improvement is the best next step.

Setting Priorities: The Conventional View

That said, many who do not measure AE Outcomes still look to external third parties and “the word on the street” to fashion patient safety strategies. For example, Becker’s Hospital Review, a widely read news source, a few days ago published, “5 top safety issues for hospitals to address in 2022.”

Let’s take a look at each of these conventional calls to action and suggest how an AE Outcomes-driven approach would rethink each:

  1. Foundational safety work. Starting with a foundation is absolutely correct, but the foundation is not a plan that excludes measuring and managing with safety outcomes, more specifically clinically validated adverse event outcomes using EHR data (“AE Outcomes”). While cultural interventions that the field has traditionally relied upon – almost exclusively in some quarters – are necessary, they are not sufficient. Pascal was the first organization in healthcare to measure the culture of safety at scale with a common scientifically validated method across leading health systems (e.g. Johns Hopkins, Ascension Health, Kaiser, Mass Gen Brigham, Advent Health, and others) but ultimately recognized the limitations of that approach. Indeed, measuring outcomes to improve performance is foundational in any domain. Field leaders, who historically have not had AE Outcomes, can now move forward in building a foundation that includes AE Outcomes.
  2. Supporting the healthcare workforce. The pandemic has placed enormous, even unfathomable, pressures on the nurses, physicians, clinical teams, and healthcare workers. In light of the industry’s embrace of virtual care technologies and methodologies, one timely way to support the healthcare workforce is by deploying remote patient safety monitoring and support such as through Pascal’s Virtual Patient Safety (VPS). VPS provides up to 24/7/365 (depending on SLA) services enabling continuous identification of safety vulnerabilities, quality variation, and risks (e.g. potentially compensable events), resulting in (1) clinicians focusing on delivering care and using accurate, timely, and actionable adverse event data; and (2) identifying and avoiding/mitigation glitches and gaps that are more likely to occur in health systems suffering from short-staffed teams, turnover, and the risks of new teams (when the literature has shown communication problems are most likely to occur). Knowing that there is always an expert safety system and team always there “covering my back” will contribute to “psychological safety, joy, well-being and healthy work environments.”
  3. Integrating equity into safety work. Pascal was the first in the field to identify the Social Determinants of Safety (SDOS) in the first version of our VPS white paper in 2020. In short, several peer-reviewed publications studying voluntary event reporting data in both pediatric (e.g. Stockwell, Halvorson, and Shulson) and adult settings have validated social and racial biases in data generated by voluntary event reporting, the primary way that the healthcare industry to date has sought to identify safety problems. Notwithstanding that voluntary event reporting has also been found by research to identify only approximately 5% of patient harm to begin with (with highly retrospective less actionable claims data only identifying only about 10% of harm), the evidence pointing to its bias should be a clarion call to find an alternative upon which to rely. As it turns out, because the Pascal VPS method proactively seeks to identify adverse events by applying evidence-based software logic on every single patient all the time, this method is more equitable by materially reducing if not eliminating the racial and social identification bias now associated with voluntary event reporting data.
  4. Diagnostic harm. The imperative to measure and manage patient safety with AE Outcomes is equally relevant with respect to diagnostic safety. Without the foundation of measuring AE Outcomes for all causes of harm, seeking to reduce diagnostic harm remains an exercise of target what Dr. Don Berwick calls the “particles of harm”, resulting in a non-systematic approach being apply to diagnostic error and harm that has plagued patient safety generally. Furthemore, even with respect to targeting a specific diagnostic error or harm that has outcomes data that are superior to “proxy” non-validated outcomes data (typically the issue), the question remains: how does the frequency, severity, and risks of this diagnostic error or harm compare to all of the other diagnostic errors or harms? Without doing so, a provider or health system will be relegated to “flying blind”, choosing to focus on this diagnostic error/harm or that based on gut, instinct, consensus, or anything apart from clinically validated adverse event outcome data.
  5. Healthcare-associated infections. Infection measurement, control, and prevention developed earlier than many areas of safety, benefiting from a CDC program to measure infections with clinical validation. That said, healthcare-associated infections (HAI) represent approximately only 24% of all harm according to existing research and real-world evidence. Therefore, particularly given the relatively more mature state of HAI programs, it remains critical to measure & manage all harm all the time for all patients with a solution like Pascal’s Virtual Patient Safety (VPS) solution which, as it does for other clinicians, can reduce the burden and focus infection control efforts more efficiently and effectively. Taking advantage of virtual safety intervention and improvement support is all the more timely and relevant in light of the concern of the Association for Professionals in Infection Control and Epidemiology that healthcare facilities have the appropriate level of staff and resources to manage this problem.

2022: How Shall We Then Execute?

There’s a theme here. Optimally executed patient safety programs start with AE Outcomes. Optimally executed patient safety programs improve with AE Outcomes. Optimally executed patient safety programs benefit peer review, risk management, revenue cycle, advanced analytics, and the rest of the organization with AE Outcomes.

So what’s the top patient safety priority of 2022? Measure and manage with AE Outcomes.