Identifying & Reducing Patient Harm & Quality Variation

All of Pascal’s virtual patient safety solutions are comprised of software services and companion expert services designed to improve patient safety and quality outcomes.

Anchored by 24/7 remote patient safety monitoring, Pascal’s virtual patient safety solutions enable health systems to identify and reduce safety vulnerabilities and quality variation through the optimal lens of clinically validated adverse event outcomes (“AE Outcomes”). Pascal’s virtual patient safety solutions enable clients to identify 10x-30x or more the level of patient harm as compared to voluntary event/incident reporting and claims/billing-based methods and to reduce both all-cause harm by 26%, and specific harm by 60% to 80%.

COVID-19 has increased the value of remote patient safety monitoring (RPSM) due to the increased value of remote patient monitoring (RPM). RPM improves hospital ROI after discharge, and RPSM reduces patient harm, which reduces excessive length of stay, which in turn allows a hospital to achieve ROI from RPM faster.

The following is a select summary of solution benefits and features.

First, find the harm

Pascal virtual patient safety solutions use an evidence-based accurate, timely, and actionable method of identifying patient harm, specifically clinically validated adverse event outcomes using real-time EHR data (“AE Outcomes”). Clients use these AE Outcomes and related intelligence both identify and reduce safety vulnerabilities and related quality variation. But it also starts with the imperative to, “First, find the harm.”

This is in contrast to voluntary event/incident reporting and claims data of identifying only 5% and 10% of adverse events, respectively. Pascal’s virtual patient safety (VPS) solution enables clients to identify 10x-30x the levels of harm as found by traditional approaches using reporting/claims data.

Clients use this AE Outcomes “lens” to achieve higher visibility into patient harm, including but not limited to the following:

  • All-cause harm (i.e. all causes of harm extending beyond errors, HACs, and such) by patient
  • Specific patient harm types by patient (e.g. hypoglycemia; renal injury; bleeding events; and so on)
  • Concurrent patient-specific care event data (seconds/minutes/hours-old) as well as retrospective (days/weeks/months-old)
  • Aggregation of all-cause harm and specific harm patient-specific events at population levels
  • Patterns of patient harm as well as contributing factors across the above
  • Quality variation into which adverse events provide distinctive, if not unique, visibility and insight, both at patient-specific and population levels
  • And much more

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Reduce safety vulnerabilities & quality variation

Having identified safety vulnerabilities and quality variation through EHR-based harm monitoring and measurement, Pascal virtual patient safety expert clinical teams support their clients in using AE Outcomes and related clinical intelligence to support concurrent intervention and high frequency cycles of improvement.

For most client teams even at healthcare delivery systems experienced in traditional patient safety and quality improvement, help is needed: the volume, velocity, and variety of data in this AE Outcomes data stream is typically overwhelming and difficult to manage without additional education, training, coaching, and support — which Pascal Clinical Services provides through both the Risk Trigger Subscription and required companion expert services such as the Safety Advisory Subscription — two key services of Pascal virtual patient safety solutions.

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Assess High Reliability Progress with Reliable Outcomes Measurement

Many health systems are aspiring to high reliability but yet rely on the unreliable method of voluntary event reporting to assess progress. While event reporting is a source of learning (and particularly helpful for near-miss safety events), this “see something, say something” approach is not a valid source of measurement.

The opportunity for health systems is to use a reliable source of measurement, namely an evidence-based outcomes-driven method such as using Pascal’s AE Outcomes “engine” that scales patient safety measurement enterprise-wide — all delivered by virtual patient safety solutions.

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Realize Value through Heterogeneous Use Cases

Virtual patient safety solutions enable health systems to:

  • Identify events of patient harm not otherwise discernible through alternative methods, including but not limited to event reporting, population management, EHR, and clinical decision support systems
  • Identify patterns of patient harm not otherwise discernible through alternative methods, creating a far more clinically effective and operationally efficient way to identify common causes of all-cause harm and specific harm
  • Activate concurrent intervention and quality improvement cycles in minutes/hours/days (high frequency) versus weeks/months/years (rapid cycle) and realize gains faster along with compounding benefits than traditional methods permit

Sample opportunities for safety and quality improvement successfully supported by Pascal’s virtual patient safety solution have included but have not been limited to:

  • Population-level, diffuse: an increased rate of central line associated thrombosis was discovered across a large facility; frontline caregivers were aware of the rare individual case on their unit, but blind to cases occurring elsewhere in the facility
  • Clinical skills deficit: a hospital was able to discover a pattern of incorrectly diagnosing and documenting dermatitis as pressure ulcers — this pattern was costing significant overtreatment and non-reimbursable cost; the hospital implemented a program of education for nurses to recognize and treat the condition appropriately
  • Inappropriate practice: a hospital identified that nurse practitioners were routinely administering anesthetic reversal agents to patient immediately post-procedure without documented reasons and in contravention of hospital protocol; the hospital was able to spot this pattern and address the issue to prevent further harm
  • Dangerous protocol: a hospital uncovered a high incidence of anticoagulation-induced bleeding with events ranging from slight harm events through to death across the facility; this pattern recognition allowed the hospital to revisit its anticoagulation protocols, find the flaw and implement a revised procedure
  • Serious Safety Events: a hospital was surprised to see a high number of serious safety events not reported or otherwise known about e.g., through voluntary event reporting; this recognition enabled the hospital to revisit this situation and perform targeted quality improvement in each specific and serious issue
  • Patient-level, complex: it was identified that a patient had repeatedly been given a nephrotoxic drug that was no longer clinically indicated over a complicated set of readmissions leading to acute kidney injury; this pattern was identified in real-time and allowed the frontline care team to be notified

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Develop and protect your “culture of safety”

All of Pascal’s virtual patient safety solutions enabling clients to identify and reduce patient harm is done as a Patient Safety Organization (PSO), which has been certified by the U.S. government pursuant to the Patient Safety and Quality Improvement Act of 2005. Further, Pascal was the first PSO audited by the U.S. government using real-time clinical data to identify, track, and manage all-cause harm. Pascal’s PSO was designed to clinically, technically, and operationally enable clinical teams to take advantage of multiple data streams in a timely manner, including while the patient is receiving care.

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Assessing and improving organizational culture

The performance of Pascal virtual patient safety solutions is enhanced by doing this work within a healthy “culture of safety”. Pascal Culture Survey Subscriptions enable health systems to:

  • Assess your organization’s culture of safety and capacity for high reliability organizing (HRO) with a valid scientific instrument, with the AHRQ Survey on Patient Safety (SOPS) highly recommended
  • Conduct an integrated survey combining domains that span patient safety, employee engagement, burnout, and other critical areas of organizational culture
  • Reduce organizational fatigue, financial cost, and improve clarity of clinical analytics by leveraging Pascal Survey’s integrated survey application

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