Dashboard: Patient Safety Initiatives – November 2014

Oct. 22, 2014

Readmissions

New strategies for reducing readmissions

By Matthew W. Tanzer, Chief Outcomes Officer, RightCare Solutions

In the past several years, there has been an explosion of health technologies that claim to have the magic bullet for decreasing readmissions. If you have a Google Alert for “readmissions,” then you too are bombarded with upwards of a dozen different announcements each day touting the newest shiny object in the fight against unnecessary rehospitalizations.

Many of the new health IT applications enable remote monitoring or telehealth that extends the reach of the care team beyond the walls of the hospital. Some seek to improve post-discharge patient engagement with the magic of gamification, while others include secure text messaging and medication adherence apps.  According to Grand View Research, the global mHealth market alone is projected to exceed $49.1 billion by 2020.

Too often providers evaluate these types of technologies in a silo and without an understanding of the foundational elements that will make them successful over the long term. To truly unlock their potential, there are three underpinnings that must be in place: patient stratification, resource matching and a connected feedback loop.

Consider “Lauren,” a VP of Care Transitions at a 330-bed community hospital. She has just ordered wireless scales for her recently discharged congestive heart failure (CHF) patients, having read a study that pointed to a substantial reduction in readmissions for patients who went home with such a device. In order for this initiative to be a lasting success, she should ensure that the following backbone is in place:

  • Patient stratification – Patients are people too. Spreading one’s time and resources indiscriminately means that some will get missed, running their risk of readmission ever higher. By predicting patient needs and risk of readmission at the time of admission, Lauren can leverage a key capability of recent health IT innovation.
  • Resource matching – Not every post-acute care intervention is right for every patient. Lauren needs to ensure patients are matched with the post-acute care that’s most appropriate for them, which means not wasting wireless scales on patients who will not benefit from having one in their home. In the emerging world of bundled payments, using technology to make these determinations is even more critical. 
  • Connected feedback loop – Gone are the days when providers could discharge a patient and not think about them until they returned. Health IT can ensure tight communication and data sharing between care settings, allowing Lauren and her team to intervene before a patient is readmitted.

Only with those foundational elements in place can Lauren design a robust, efficient post-acute care intervention that will improve the lives of the patients under her care.

Alarms

Minimize the No. 1 health tech hazard

ECRI Institute has published “The Alarm Safety Handbook: Strategies, Tools, and Guidance” to support hospital efforts to meet the Joint Commission’s 2014 National Patient Safety Goal on clinical alarm safety. Alarm hazards are the No. 1 danger on ECRI Institute’s 2014 Top 10 Health Technology Hazards list. The emergency care research nonprofit has raised awareness about the patient safety risks from alarm fatigue and other alarm-related hazards for years.

The handbook features charts, statistics, guidance, key points and questions, along with a separate workbook of customizable tools. Topics include:

  • Making alarm management a patient safety priority;
  • Understanding clinical alarm hazards – a conceptual model;
  • Creating an action plan;
  • Putting the plan into action; and
  • Identifying best practices.

The tools in the accompanying workbook are designed to help hospitals identify safety vulnerabilities and develop alarm management strategies. Examples include a care area assessment checklist, a nursing staff survey and an alarm review tool.

The handbook and companion workbook are available in print or electronic formats from www.ecri.org. ECRI member organizations may receive a discounted rate on the materials.

Claims and Coding

ICD-10 may impact hospital safety evaluations

A new report by researchers at the University of Illinois at Chicago (UIC) says that the ICD-10 international disease classification system may complicate the assessment of hospital safety, including safety indicator evaluations that are published for consumers on websites (such as hospitalcompare.hhs.gov) and in U.S. News and World Reports’ hospital rankings. Hospital reputations can hinge on these rankings.

The report, “Challenges and remediation for Patient Safety Indicators in the transition to ICD-10-CM,” was posted online in September in the Journal of the American Medical Informatics Association (JAMIA).

The researchers looked at issues that could arise as hospitals change from the ICD-9 system to ICD-10. Although some ICD-9 indicator codes may translate or “map” well, many more have very convoluted mappings – and some simply don’t map at all.

Codes for diagnoses that serve as patient safety indicators may not translate in a simple way from ICD-9 to ICD-10, said Andrew Boyd, Assistant Professor of Biomedical and Health Information Sciences at UIC, in a university statement. Boyd is the first author of the paper.

“It’s possible to select ‘accurate’ new ICD-10 codes that make you look safer than you are because of the differences in the design of the ICD-10 system,” Boyd said. At the same time, some hospitals may look less safe than they really are because of apparent increases in patient safety indicators that are actually the same indicators calculated differently.

Source: University of Illinois at Chicago

Solutions

Praise from nurses for patient safety

According to the April 2014 KLAS Research report titled, “Medication Cabinets, Carts, & BCMA 2014: Technology’s Impact on Nurse Efficiency and Patient Safety,” Rubbermaid Healthcare’s medication carts were rated highly in both nurse efficiency and patient safety compared to five other vendors in the survey of 177 nurses. Rubbermaid Healthcare’s latest generation of lockable medication carts allow users to manage and monitor access to medication drawers remotely, making it easier to proactively manage a fleet of carts. Rubbermaid Healthcare

Create accurate IDs on the go

The wireless, mobile format Brother TD-2130NHC healthcare thermal printer with TrustSense smart technology prints crisp, accurately imaged wristbands and labels using PDC Healthcare media at almost any point-of-care location, from a workstation in admissions to a cart at patient bedside. TrustSense smart technology allows users to conveniently load and print both wristbands and labels without special setup or calibration. Optional Li-ion battery, WLAN or Bluetooth interface and touch-panel display provide extreme versatility. Brother Mobile Solutions

Keep the whole team connected

The Spok Mobile version 4.0 messaging app for Apple and Android gives healthcare providers an efficient, secure messaging platform to share images, videos and text, and make quick connections for better patient care. This encrypted solution gives providers fast access to the full staff directory and up-to-date on-call schedules, and it contains prioritized messaging capabilities, full audit trails and automatic escalations. A key new feature called Spheres lets users create multiple groups of colleagues within the app. Spok Mobile was formerly Amcom Mobile Connect. Spok

Analytics-based approach to care management

McKesson Care Manager provides a streamlined, analytics-informed workflow that identifies, stratifies and prioritizes patients needing support and a single work queue that helps care managers manage their daily tasks. The solution uses automated, rules-based algorithms to update care plans with recent changes to clinical, lab and medication data, along with risk scores and utilization cost and likelihood of admission data. This solution enables a proactive team approach to patient care using consistent guidelines and access to a comprehensive patient record and care plan. McKesson

Detect unauthorized Web-portal access

FraudMAP Access adds a layer of security beyond user name and password to protect personal data, healthcare records and sensitive internal information. This solution uses Dynamic Account Modeling to create and continually update models of legitimate access behavior for each user. When a criminal (or unscrupulous caregiver, friend or family member) compromises an account, FraudMAP Access will detect differences relative to established, typical behavior for the legitimate user or patient and provide alerts to high-risk activity. Guardian Analytics

Scan with feeling

The easy-to-use DS4308-HC 2D imager offers an extended read range, enabling users to scan bar codes of any density nearer and farther than any other scanner in its class. For scanning at the patient bedside, this unit captures data from curved reflective surfaces and provides haptic feedback so patients are not disturbed. IP42 sealing and a specially designed, disinfectant-ready plastic housing help prevent the spread of germs. Motorola Solutions

Top med reference app five years running

According to Manhattan Research’s 2014 Taking the Pulse U.S. study, Epocrates leads the digital health market in terms of medical reference app reach on smartphones for the fifth consecutive year. More than 3,000 physicians shared their opinions in the survey, which found that Epocrates is the most popular medical reference application on smartphone and tablet devices among U.S. physician app users, and that nearly one-third of physician users launch the app three or more times a day for drug and clinical references. Epocrates, an athenahealth service

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