I considered dozens of patient care issues for this post. I chose these five for their relevance to the practicing clinician.
1. Lack of Electronic Health Records (EHRs) Interoperability
A recent KLAS Research report showed that less than 15% percent of hospitals and clinics indicated they have "deep interoperability" when sharing data among different EHRs. When EHRs can’t communicate and data is not integrated, patient care suffers. Physicians don’t have the patient’s entire history in one place. And in an emergency situation, there may not be time to go after all the pieces.
One of the most concerning patient care issue when EMRs aren’t integrated is medication reconciliation. If physicians don’t know all the medications a patient is taking, the chance that they prescribe something that interacts with something else they are taking is high. These “medication blind spots” are a significant issue for hospitals, especially in the emergency department.
2. Hand Hygiene
In the 1840s, Hungarian physician Ignaz Semmelweis was the first to identify the connection between women contracting “childbed syndrome” in the maternity ward, and the physicians who treated them after performing autopsies and not disinfecting their hands. Problem was, some physicians were furious that Semmelweis implicated them in the deaths of their patients, and others simply didn’t believe his research that washing hands with chlorine could kill the germs that caused infection.
Fast forward to modern times and although no one is debunking hand hygiene as important, it’s still linked to many infections and deaths in the U.S.
The CDC has developed a succinct resource guide that explains effective techniques for provider and patient hand washing, as well as what patients should watch prior to being examined by a physician. According to a study published by the American Journal of Infection Control, giving patients a sign to hold as a reminder to providers to wash or glove their hands, can be effective. And, mobile tools such as iScrub Lite, listed in our recent post, 13 Patient Care Apps Clinicians Will Love is a simple observation and tracking app that can be used to record and email results of whether providers have followed hand hygiene protocols.
3. Adverse Drug Events (ADEs)
The Centers for Disease Control (CDC) reports that ADEs cause approximately 1.3 million emergency department visits and 350,000 hospitalizations each year. And $3.5 billion is spent on excess medical costs of ADEs annually.[1] According to the Institute for Health Care Improvement (IHI), adverse drug events (ADEs) present the single greatest risk of harm to patients in hospitals.
Historically, ADEs have been voluntarily reported and tracked. But that has led to only a small portion of errors being reported. Public health researchers have established that only 10%-20% of errors are ever reported and, of those, 90%-95% cause no harm to patients.[2] Thus, the most serious ADEs are not even being reported.
IHI has stepped up to lead an effort that measures ADEs per 1,000 medication doses over time in a hospital, which can demonstrate improvement. The organization’s goal is for hospitals to decrease the number of ADEs per 1,000 doses by 75 percent within 1 year.
4. Nurse-Patient Ratios
I covered this topic in the recent post, 4 Patient Safety Issues in Nursing but it bears repeating because it’s such a serious issue in hospitals. The result of our national nursing shortage coupled with tighter budgets has pushed the nurse-patient ratio to unsafe levels in many hospitals.
When one nurse is forced to care for too many patients, tasks can be overlooked and patients can be injured. One study showed that for every extra patient on a nurse's caseload, mortality rates increased by 7 percent. New bills the House and Senate are focused on mandating appropriate nurse-to-patient staffing ratios in hospitals.[3] But until that happens, and hospitals can hire enough nurses to meet the requirements, nurse-patient ratios in some hospitals will continue to be precarious.
5. Physician Burnout
In response to Medscape’s most recent annual national physician survey, 42% of physicians said they have feelings of burnout. 15% reported they feel depressed. And surveys show that a big source of burnout is due to the daily administrative burdens and desk work physicians face, such as entering data into the EHR, obtaining pre-authorizations, and handling insurance company bureaucracy.
Why is physician burnout such a big deal? Unhappy, burned out doctors aren’t as able to engage with their patients. If a physician’s emotional well-being is at risk or he or she isn’t well-rested, ADEs and medical errors occur.
Many health systems are scrambling to re-think schedules and workflows to address the issue. Stress reduction, coaching, apps, and other resources are popping up for physicians - many of them developed by physicians. Check out TheHappyMD, as one example.
I think we are seeing just the tip of the iceberg on this one. I don’t think we know the end game yet, but it’s almost certain to have a domino effect on EHR product development, hospital staffing, and medical training.
[1] https://www.cdc.gov/medicationsafety/basics.html
[2] http://www.ihi.org/resources/Pages/Measures/ADEsper1000Doses.aspx
[3] https://www.healthcaredive.com/news/fight-for-mandated-nurse-to-patient-ratios-heats-up/525225/
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