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EHR Use, Data Stewardship Shortfalls Top 2019 Patient Safety Concerns

Patient safety faces significant threats from incorrect EHR use, gaps in data stewardship, and poor communication among staff members, says the ECRI Institute.

Patient safety, EHR use, and data analytics

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By Jennifer Bresnick

- Organizational challenges with EHR use and data stewardship strategies are at the top of this year’s ECRI Patient Safety Concerns list, indicating that healthcare providers are still finding it difficult to leverage their health IT tools safely and consistently.

Seven out of the ten items on the list directly touch the world of data analytics and data management, highlighting the importance of developing comprehensive processes and deploying those processes clearly and cohesively across a healthcare system.

Topping the 2019 edition of the list is errors related to diagnostic stewardship and test results using electronic health records, the non-profit ECRI Institute says.

“When diagnoses and test results are not properly communicated or followed up, the potential exists to cause serious patient harm or death,” the report cautions.

Providers must learn how to use digital tools to correctly report upon and share diagnostic data.  That means following organizational procedures for documentation and follow-up other with members of the care team, says Patricia Stahura, RN, MSN, senior analyst and consultant, ECRI Institute.

READ MORE: Using Big Data Analytics for Patient Safety, Hospital Acquired Conditions

“The information must be accurate and must be written so that future clinicians looking at the EHR can understand it,” she said. “If you have faulty information or missing test results, you are predisposed to making a diagnostic error.”

“You need to have all the information and test results available, and you have to know when and where to look for that information to make the right diagnosis. If you don’t get the diagnosis right, appropriate care cannot follow.”

While correct usage of the EHR is extremely important for patient safety, poorly designed software, insufficient governance, and convoluted internal processes are known to be a contributing factor to the number three item on the ECRI list: provider burnout.

Burnout is strongly associated with patient safety errors, since stressed, overworked, and distracted providers are unable to offer the highest quality care. 

“Healthcare is evolving rapidly and keeping up with the changes can be a challenge,” ECRI acknowledged. “Time pressures are intense. Providers are caring for an increasing number of patients with complex medical conditions, drawing on limited resources.”

READ MORE: EHR Natural Language Processing Errors Bring Patient Safety Concerns

While these problems are likely to include health IT frustrations, the EHR is by no means the only factor contributing to burnout, and should not be viewed as such.

Instead, organizational leaders must focus on fostering a culture of caring and supportiveness, ECRI says.

“If burnout is to be addressed effectively, organizations must listen to providers’ concerns about workload, performance criteria, and suboptimal resource allocation and fix these problems at a system level.”

“Leadership must strive to make providers feel they are treated as human beings, whose opinions and abilities are valued, rather than as cogs in a wheel.”

Focusing on creating a more positive working environment can help organizations address the other significant patient safety concerns on the list, including reducing discomfort with behavioral health for both patients and providers, as well as developing communication skills to support safe and effective transitions of care.

READ MORE: EHR Metadata Could Enhance Clinical Decision Support Alerts

Failure to communicate changes in a patient’s condition, the sixth item on the list, often occurs when teams do not work smoothly together or individual staff members are overwhelmed or unable to focus on a single task.

“Patient safety may be jeopardized when there is a lack of detailed communication back to the provider to address whatever the issue is at hand,” says Kelly C. Graham, BS, RN, patient safety analyst, ECRI Institute.

Transitions of care are particularly challenging, the report notes, and key information can be lost if providers fail to follow procedures.

“Technology can alert caregivers to a patient’s changing condition, but it must be used appropriately,” ECRI says. 

Organizations must pay close attention to setting alarms and alerts within their clinical decision support tools in order to avoid alarm fatigue or flood providers with low-value information.

Developing and deploying meaningful clinical decision support tools may help providers address two additional items on the list: detecting sepsis early and preventing infection from IV lines.

Analytics tools, increasingly based in artificial intelligence, can alert providers to early signs of infection and guide clinicians through steps to combat the problem.

But these health IT tools will not be effective if alarms are improperly configured – or ignored by providers.

“Staff must be trained in how to operate the equipment and understand the organization’s policies and their responsibilities for responding to alarms,” states the report.  

Healthcare providers can develop and maintain these skills in their staff members by running regular training and simulation programs, ECRI says.  Adequate training and refresher courses are critical for patient safety, especially when team-based protocols are involved.

“Simulations can be designed for individuals to practice and learn technical skills or for healthcare teams to conduct drills of situations that may occur infrequently but require knowledge of other team members’ roles and capabilities,” states the report.

“Debriefings, an essential component of simulation training, are provided by a facilitator who observes the simulation and gives feedback—sometimes while the trainee is practicing skills or, for more complex scenarios such as team interactions, at the end of the simulation.”

Defining governance and reinforcing correct processes for safeguarding patients and using data analytics tools will only gain importance as health systems consolidate and grow in size, the report concludes.

“Healthcare organizations as we used to know them are now becoming nationwide ‘megasystems,’” says Sheila Rossi, MHA, manager, ECRI Institute PSO. “How do you keep patient safety at the forefront? How do organizations internally structure themselves to address patient safety needs?”

Seamless and continuous communication across care teams is an important pillar of patient safety that can support more effective care delivery. 

While health IT tools, including EHRs and clinical decision support systems, play a major role in fostering communication and sharing information appropriately, organizations cannot ignore the human factors that contribute to quality patient care.

ECRI suggests that healthcare organizations focus on universal strategic planning and uniform implementation of patient safety procedures while incorporating provider viewpoints and expert analysis of the healthcare environment.

“Regardless of organization size, the goal is to institute structures that effectively allow patient safety leaders to support organization leadership in engaging with patient safety priorities,” the organization stressed.

With strong governance and cohesive training across an organization, healthcare providers will be able to deliver care and leverage data analytics and EHR tools in a safe and effective manner.

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