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Artificial intelligence (AI) has tremendous potential to improve the cognitive and work burden of clinicians across a range of clinical activities, which could lead to reduced burnout and better clinical care. The recent explosion of generative AI nicely illustrates this potential. Developers and organizations deploying AI have a responsibility to ensure AI is designed and implemented with end-user input, has mechanisms to identify and potentially reduce bias, and that the impact on cognitive and work burden is measured, monitored, and improved. This article focuses specifically on the role AI can play in reducing cognitive and work burden, outlines the critical issues associated with the use of AI, and serves as a call to action for vendors and users to work together to develop functionality that addresses these challenges.
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Since the original Institute of Medicine (IOM) report was published there has been an accelerated development and adoption of health information technology with varying degrees of evidence about the impact of health information technology on patient safety. This article is intended to review the current available scientific evidence on the impact of different health information technologies on improving patient safety outcomes. We conclude that health information technology improves patient's safety by reducing medication errors, reducing adverse drug reactions, and improving compliance to practice guidelines. There should be no doubt that health information technology is an important tool for improving healthcare quality and safety. Healthcare organizations need to be selective in which technology to invest in, as literature shows that some technologies have limited evidence in improving patient safety outcomes.
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Informática Médica , Seguridad del Paciente , Humanos , National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division , Estados UnidosRESUMEN
OBJECTIVE: Evaluate application of quality improvement approaches to key ambulatory malpractice risk and safety areas. STUDY SETTING: In total, 25 small-to-medium-sized primary care practices (16 intervention; 9 control) in Massachusetts. STUDY DESIGN: Controlled trial of a 15-month intervention including exposure to a learning network, webinars, face-to-face meetings, and coaching by improvement advisors targeting "3+1" high-risk domains: test result, referral, and medication management plus culture/communication issues evaluated by survey and chart review tools. DATA COLLECTION METHODS: Chart reviews conducted at baseline and postintervention for intervention sites. Staff and patient survey data collected at baseline and postintervention for intervention and control sites. PRINCIPAL FINDINGS: Chart reviews demonstrated significant improvements in documentation of abnormal results, patient notification, documentation of an action or treatment plan, and evidence of a completed plan (all P<0.001). Mean days between laboratory test date and evidence of completed action/treatment plan decreased by 19.4 days (P<0.001). Staff surveys showed modest but nonsignificant improvement for intervention practices relative to controls overall and for the 3 high-risk domains that were the focus of PROMISES. CONCLUSIONS: A consortium of stakeholders, quality improvement tools, coaches, and learning network decreased selected ambulatory safety risks often seen in malpractice claims.
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Atención Ambulatoria , Mala Praxis/tendencias , Atención Primaria de Salud , Gestión de Riesgos/organización & administración , Adulto , Anciano , Encuestas de Atención de la Salud , Humanos , Massachusetts , Persona de Mediana Edad , Seguridad del Paciente , Estudios Retrospectivos , Adulto JovenRESUMEN
INTRODUCTION: After an adverse event, not only patients and family members but also health-care professionals involved in the event become victims. More than 50% of all health-care professionals suffer emotionally and professionally after being involved in an adverse event. Support is needed for these "second victims" to prevent a further negative impact on patient care. OBJECTIVES: The aim of the study was to evaluate the prevalence and content of organizationallevel support systems for health-care professionals involved in an adverse event. METHODS: A survey was sent to 109 Belgian hospitals regarding 2 aspects: first, the availability of a protocol for supporting second victims; and, second, the presence of a contact person in the organization to provide support. A total of 59 hospitals participated in the study. Hospitals were asked to submit their protocols for providing support to second victims. A content analysis based on an Institute for Healthcare Improvement's white paper and the Scott Model was performed to evaluate the protocols. RESULTS: Thirty organizations had a systematic plan to support second victims. Twelve percent could not identify a contact person. The chief nursing officer was seen as one of the main contact people when something went wrong. In terms of the quality of the protocols, only a minority followed part of the international resources. CONCLUSIONS: A minority of hospitals are somewhat prepared to provide support for health-care professionals. Management should take a leadership role in establishing support protocols for their health-care professionals in the aftermath of an adverse event.
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Personal Administrativo/psicología , Actitud del Personal de Salud , Personal de Salud/psicología , Errores Médicos/psicología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Lugar de TrabajoRESUMEN
BACKGROUND: Total joint arthroplasty (TJA) is one of the most widely performed elective procedures; however, there are wide variations in cost and quality among facilities where the procedure is performed. QUESTIONS/PURPOSES: The purposes of this study were to (1) develop a generalizable clinical care pathway for primary TJA using inputs from clinical, academic, and patient stakeholders; and (2) identify system- and patient-level processes to provide safe, effective, efficient, and patient-centered care for patients undergoing TJA. METHODS: We used a combination of quantitative and qualitative methods to design a care pathway that spans 14 months beginning with the presurgical office visit and concluding 12 months after discharge. We derived care suggestions from interviews with 16 hospitals selected based on readmission rates, cost, and quality (n = 10) and author opinion (n = 6). A 32-member multistakeholder panel refined the pathway during a 1-day workshop. Participants were selected based on leadership in orthopaedic (n = 4) and anesthesia (n = 1) specialty societies; involvement in organizations specializing in safety and high reliability care (n = 3), lean production/consumption of care (n = 3), and patient experience of care (n = 3); membership in an interdisciplinary care team of a hospital selected for interviewing (n = 8); recent receipt of a TJA (n = 1); and participation in the pathway development team (n = 9). RESULTS: The care pathway includes 40 suggested processes to improve care, 37 techniques to reduce waste, and 55 techniques to improve communication. Central themes include standardization and process improvement, interdisciplinary communication and collaboration, and patient/family engagement and education. Selected recommendations include standardizing care protocols and staff roles; aligning information flow with patient and process flow; identifying a role accountable for care delivery and communication; managing patient expectations; and stratifying patients into the most appropriate care level. CONCLUSIONS: We developed a multidisciplinary clinical care pathway for patients undergoing TJA based on principles of high-value care. The pathway is ready for clinical testing and context-specific adaptation. LEVEL OF EVIDENCE: Level V, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
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Artroplastia de Reemplazo , Vías Clínicas , Prestación Integrada de Atención de Salud , Evaluación de Procesos y Resultados en Atención de Salud , Atención Dirigida al Paciente , Mejoramiento de la Calidad , Indicadores de Calidad de la Atención de Salud , Artroplastia de Reemplazo/efectos adversos , Artroplastia de Reemplazo/economía , Artroplastia de Reemplazo/normas , Actitud del Personal de Salud , Conducta Cooperativa , Análisis Costo-Beneficio , Vías Clínicas/economía , Vías Clínicas/normas , Prestación Integrada de Atención de Salud/economía , Prestación Integrada de Atención de Salud/normas , Costos de la Atención en Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Comunicación Interdisciplinaria , Evaluación de Procesos y Resultados en Atención de Salud/economía , Evaluación de Procesos y Resultados en Atención de Salud/normas , Grupo de Atención al Paciente , Educación del Paciente como Asunto , Seguridad del Paciente , Atención Dirigida al Paciente/economía , Atención Dirigida al Paciente/normas , Relaciones Médico-Paciente , Desarrollo de Programa , Mejoramiento de la Calidad/economía , Mejoramiento de la Calidad/normas , Indicadores de Calidad de la Atención de Salud/economía , Indicadores de Calidad de la Atención de Salud/normas , Derivación y Consulta , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Estados Unidos , Flujo de TrabajoRESUMEN
Identification and measurement of adverse medical events is central to patient safety, forming a foundation for accountability, prioritizing problems to work on, generating ideas for safer care, and testing which interventions work. We compared three methods to detect adverse events in hospitalized patients, using the same patient sample set from three leading hospitals. We found that the adverse event detection methods commonly used to track patient safety in the United States today-voluntary reporting and the Agency for Healthcare Research and Quality's Patient Safety Indicators-fared very poorly compared to other methods and missed 90 percent of the adverse events. The Institute for Healthcare Improvement's Global Trigger Tool found at least ten times more confirmed, serious events than these other methods. Overall, adverse events occurred in one-third of hospital admissions. Reliance on voluntary reporting and the Patient Safety Indicators could produce misleading conclusions about the current safety of care in the US health care system and misdirect efforts to improve patient safety.
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Hospitales , Errores Médicos/estadística & datos numéricos , Femenino , Mortalidad Hospitalaria , Humanos , Masculino , Auditoría Médica , Persona de Mediana Edad , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Estudios Retrospectivos , Estados Unidos/epidemiologíaRESUMEN
As many as 32% of medication errors occur during administration, so there's good reason to find effective methods to minimize these error opportunities.
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Procesamiento Automatizado de Datos , Errores de Medicación/enfermería , Errores de Medicación/prevención & control , Sistemas de Medicación en Hospital , Sistemas de Identificación de Pacientes , HumanosRESUMEN
The medication use process is one of the most complex and risky clinical care processes in the hospital. It involves a large number of caregivers in widely diverse areas: physicians, nurses, pharmacists and respiratory therapists. Studies performed over the past several years have shown that medication errors and adverse events occur in all parts of the medication use process. Technologies are available to improve medication safety across the entire medication use process, but implementation can be expensive, intrusive and complex. To gain the benefits from various technologies, organizations must consider how the interplay between these technologies affects the workflow and how best to implement these technologies. Our approach for planning for these implementations--along with a suggested sequence--will be discussed in this article.
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Automatización , Errores de Medicación/prevención & control , Sistemas de Medicación en Hospital , Administración de la Seguridad/organización & administración , Ciencia del Laboratorio Clínico , Sistemas de Entrada de Órdenes Médicas , Sistemas de Medicación en Hospital/organización & administración , Innovación OrganizacionalRESUMEN
OBJECTIVES: Narcotic-related adverse drug events are the most common adverse drug events in hospitalized children. Despite multiple published studies describing interventions that decrease adverse drug events from narcotics, large-scale collaborative quality improvement efforts to address narcotic-related adverse drug events in pediatrics have not been described. The purpose of this study was to evaluate collaborative-wide narcotic-related adverse drug event rates after a collection of expert panel-defined best practices was implemented. METHODS: All 42 children's hospitals in the Child Health Corporation of America were invited to participate in the Institute for Healthcare Improvement-style quality improvement collaborative aimed at reducing narcotic-related adverse drug events. A collection of interventions known or suspected to reduce narcotic-related adverse drug events was recommended by an expert panel, with each site implementing >or=1 of these best practices on the basis of local need. Narcotic-related adverse drug event rates were compared between the baseline (December 1, 2004, to March 31, 2005) and postimplementation periods (January 1, 2006, to March 31, 2006) after an a priori-defined intervention ramp-up time (April 1, 2005, and December 31, 2005). Secondary outcome measures included constipation rates and narcotic-related automated drug-dispensing-device override percentages. RESULTS: Median narcotic-related adverse drug event rates decreased 67% between the baseline and postimplementation time frames across the 14-site collaborative. Constipation rates decreased 68.9%, and automated drug-dispensing-device overrides decreased from 10.18% to 5.91% of all narcotic doses administered. CONCLUSIONS: Implementation of >or=1 expert panel-recommended interventions at each participating site resulted in a significant decrease in narcotic-related adverse drug events, constipation, and automated drug-dispensing-device overrides in a 12-month, 14-site children's hospital quality collaborative.
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Sistemas de Registro de Reacción Adversa a Medicamentos/organización & administración , Niño Hospitalizado/estadística & datos numéricos , Hospitales Pediátricos/estadística & datos numéricos , Errores de Medicación/estadística & datos numéricos , Narcóticos/efectos adversos , Trastornos Relacionados con Opioides/epidemiología , Niño , Monitoreo de Drogas/métodos , Estudios de Seguimiento , Humanos , Incidencia , Errores de Medicación/prevención & control , Trastornos Relacionados con Opioides/prevención & control , Estudios Retrospectivos , Gestión de Riesgos , Administración de la Seguridad , Estados Unidos/epidemiologíaAsunto(s)
Errores de Medicación/prevención & control , Grupo de Atención al Paciente/organización & administración , Farmacéuticos/organización & administración , Rol Profesional , Resucitación/métodos , Urgencias Médicas , Paro Cardíaco/tratamiento farmacológico , Humanos , Modelos Organizacionales , Enfermeras Administradoras/organización & administración , Insuficiencia Respiratoria/tratamiento farmacológicoRESUMEN
BACKGROUND: One of the 12 interventions that the Institute for Healthcare Improvement (IHI) recommends for its 5 Million Lives Campaign is "Prevent Harm from High-Alert Medications . . . starting with a focus on anticoagulants, sedatives, narcotics, and insulin." EXECUTING SYSTEM-LEVEL CHANGES: Three essential elements are needed to execute system-level changes in an organization: will, ideas, and execution. Will is developed by examining the status quo in an organization and agreeing that it is no longer acceptable. Ideas-changes that will make the system safer-can be found in the literature and in the experience of other hospitals and are the basis for the recommended general interventions to reduce errors and harm associated with high-alert medications. Execution, the process of making those changes real, requires commitment from senior leaders and clinical leaders, along with the organizational capacity to improve. The steps in the medication system are so interrelated that a change in one area will affect others' ability to complete their work. In addition, senior leadership and clinical leadership must visibly support the effort, connecting the reduction in high-alert medication-related harm to the overall hospital goal of harm reduction is essential. CONCLUSION: The campaign's goal is to achieve a 50% reduction in harm related to high-alert medications. Employing strategies such as standardization and simplification will provide the foundation for improved medication safety.
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Reducción del Daño , Errores de Medicación/prevención & control , Administración de la Seguridad/métodos , Humanos , Sistemas de Medicación en Hospital/organización & administración , Objetivos Organizacionales , Garantía de la Calidad de Atención de Salud/organización & administración , Estados UnidosRESUMEN
BACKGROUND: Fifty hospitals collaborated in a patient safety initiative developed and implemented by the Massachusetts Coalition for the Prevention of Medical Errors and the Massachusetts Hospital Association. METHODS: A consensus group identified safe practices and suggested implementation strategies. Four collaborative learning sessions were offered, and teams monitored their progress and shared successful strategies and lessons learned. Reports from participating teams and an evaluation survey were then used to identify successful techniques for reconciling medications. RESULTS: For the 50 participating hospitals, implementation strategies most strongly correlated with success included active physician and nursing engagement, having an effective improvement team, using small tests of change, having an actively engaged senior administrator, and sending a team to multiple collaborative sessions. DISCUSSION: Adoption of the reconciling safe practices proved challenging. The process of writing medication orders at patient transfer points is complex. The hospitals' experiences demonstrated that implementing the proposed safe practices requires a team effort with leadership support and vigilant measurement.
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Errores de Medicación/prevención & control , Admisión del Paciente/normas , Administración de la Seguridad , Conducta Cooperativa , Guías como Asunto , Humanos , Massachusetts , Evaluación de Programas y Proyectos de Salud/métodosRESUMEN
OBJECTIVES: Medication errors in pediatric inpatients occur at similar rates as in adults but have 3 times the potential to cause harm. Error prevention strategies in this setting remain largely untested. The objective of this study was to classify the major types of medication errors in pediatric inpatients and to determine which strategies might most effectively prevent them. METHODS: A prospective cohort study was conducted of 1020 patients who were admitted to 2 academic medical centers during a 6-week period in April and May 1999. Medication errors were characterized by subtype. Physician raters evaluated error prevention strategies and identified those that might be most effective in preventing errors. RESULTS: Of 10 778 medication orders reviewed, 616 contained errors. Of these, 120 (19.5%) were classified as potentially harmful, including 115 potential adverse drug events (18.7%) and 5 preventable adverse drug events (0.8%). Most errors occurred at the ordering stage (74%) and involved errors in dosing (28%), route (18%), or frequency (9%). Three interventions might have prevented most potentially harmful errors: 1) computerized physician order entry with clinical decision support systems (76%); 2) ward-based clinical pharmacists (81%); and 3) improved communication among physicians, nurses, and pharmacists (86%). Interrater reliability of error prevention strategy assignment was good (agreement: 0.92; kappa: 0.82). CONCLUSIONS: Of the assessed interventions, computerized physician order entry with clinical decision support systems; ward-based clinical pharmacists; and improved communication among physicians, nurses, and pharmacists had the greatest potential to reduce medication errors in pediatric inpatients. Development, implementation, and assessment of such interventions in the pediatric inpatient setting are needed.