The Evolution of Patient Safety: Moving Beyond the Automated GTT

Patient safety has evolved through a series of eras: trail-blazing in the decade of the 1990s until the milestone IOM report, To Err Is Human, in 1999; community-building in the 2000s until the milestone HITECH Act in 2009; and now we find ourselves in a period that might be described as data-gathering.

Trail-blazing resulted in the healthcare field acknowledging there was a serious problem: patient harm. Community-building resulted in broad campaigns to gather, educate, and train. Data-gathering has resulted in enterprise initiatives to identify variation.

It’s unclear what milestone will punctuate this period but, if past is prologue, we’ll find out in the next two years. Pascal’s bet is that a clue to that milestone and, more importantly, the period into which we are now moving is found in today’s publication by Annals of Internal Medicine: “Measuring Patient Safety in Real Time: An Essential Method for Effectively Improving the Safety of Care,” co-authored by Dr. David Classen, Fran Griffin, and Dr. Donald Berwick. [Full Disclosure: Dr. Classen is the CMIO of Pascal as well as on the faculty at the University of Utah.]

In it Dr. Classen (an inventor of electronic adverse event detection), Ms. Griffin (a top clinical expert in patient safety), and Dr. Berwick (widely acknowledged to be the key founder of the modern patient safety and quality movement) articulate the following key points:

  • Research has demonstrated trigger-based adverse event detection to identify more than 90% of harm in hospitalized patients, versus less than 10% by billing data and less than 5% by voluntary event reporting, the current field standard
  • Despite electronic healthcare record (EHR) penetration having reached 96% of U.S. hospitals, health systems are not using EHR data to measure, monitor, and manage safety
  • Leading health systems such as Adventist Health System, Baylor Scott & White Health, Dignity Health, Kaiser Permanente, Providence Health & Services, and Cook Children’s Health Care System have used automated EHR triggers with success
  • Surveillance for harm using EHR triggers on health IT data can be “affordable, sustainable, and actionable,” providing a population-wide approach to patient safety, just as it has in the area of infection control
  • Building on 15 years of trigger development and learning, using EHR triggers can support “a reliable approach to measuring all causes of harm in all hospitalized patients…that allows for concurrent mitigation and prevention.”
  • CMS recently announced publicly the development of a new EHR-based patient safety measure using electronic approaches

The co-authors conclude with a call to action, namely that all hospitals should use their EHR data to measure, monitor, and manage their patient safety efforts.

This is no ordinary issue. As Dr. Berwick makes clear in an accompanying video, the piece is intended to be “a plea to take the electronic health record…and look at it as a tool, a lens, through which to study and assess overall safety….”

He continues: “We propose that, at least at the first step, a way to do that would be to automate the Global Trigger Tool…to use the EHR as a window on safety and care.”

Finally, Dr. Berwick implores, “We need healthcare systems to demand it. We need hospitals and boards of trustees and leaders in hospitals, for starters, to say we need to know what the overall levels are in our organization….”

We at Pascal agree: EHR triggers properly implemented in an automated all-cause harm management system not only has been proven to work, but leading health systems are reporting that – just as Dr. Berwick reports above – EHR trigger based systems provide a unique “lenses” into their care, enabling learning not available in any other system.

It’s unclear what the next era will be named but, as long as boards and CXOs answer the Berwick call, we at Pascal predict it will be the “golden age” for patient safety.