Nearly nine out of 10 respondents to a national survey of physicians, nurses and healthcare executives say their organizations are successfully improving the safety of patients, yet these medical professionals also identified ineffective information technology as a key barrier to achieving their patient safety goals, according to a recent online survey conducted by Health Catalyst.
Specifically, respondents said they need better health information technology to warn clinicians of impending patient harm, as well as more resources and greater organizational focus on the problem, the survey found. Health Catalyst, a Salt Lake City-based data analytics company, conducted an online survey of 462 medical, quality and pharmacy professionals in healthcare organizations of all sizes across the U.S. on patient safety issues.
There is compelling evidence that the healthcare industry needs to do more to address patient safety issues. Medical error is one of the leading causes of death in the U.S. While the morality statistics are alarming, non-lethal harm events are even more frequent, occurring at a rate 10 to 20 times higher than lethal events, according to a study in The Journal of Patient Safety.
Despite the evident room for improvement, confidence in current patient safety efforts is high, according to the survey. Seventy-nine percent of survey respondents rated their organizations’ success in improving patient safety either “somewhat good” or “very good.” Only 11 percent rated their patient safety efforts as “poor.” However, on the opposite end of the scale, just 9 percent gave their efforts an “excellent” grade.
The survey results indicate that serious challenges prevent healthcare organizations from making a significant dent in preventable errors. Respondents identified several key obstacles that prevent them from achieving their patient safety goals:
- “Ineffective information technology (data quality, patient matching, reporting)” and the related “lack of real-time warnings for possible harm events,” which requires technology – 30 percent
- “Lack of resources” including staffing and budget – 27 percent
- “Organization structure, culture or priorities” – 19 percent
- “Lack of reimbursement for safety initiatives” – 10 percent
- “Changes in patient population and practice setting” – 9 percent
- “Other” – 6 percent
Organizations’ lack of effective information technology for patient safety is tied to a related finding from the survey – that healthcare organizations of all types are almost completely dependent on manual methods of tracking and reporting safety events. According to the survey, the four most common sources of data used for patient safety initiatives are voluntary reporting (selected by 82 percent of respondents), hospital-acquired infection surveys (67 percent), manual audits (58 percent), and retrospective coding (29 percent). Nearly one-third of respondents (28 percent) reported also using trigger tools as a data source for patient safety, which could mean either the manual process of chart review that relies on Institute for Healthcare Improvement (IHI) methodology, or home-grown reports that also follow the IHI methodology.
According to a study published in the Journal of Patient Safety, these standard approaches to manual reporting of hospital safety events have been shown to find less than 5 percent of all-cause harm. Manual reporting is based on data that is at least 30 days old, and it requires extensive time and resources for data extraction, aggregation, and reporting, resulting in limited root-cause analyses, the Health Catalyst survey notes.
“As these survey results confirm, the current approach to using voluntary reporting to monitor patient safety gives health care organizations a false sense of tackling the ever-present danger of patient harm,” Stanley Pestotnik, Health Catalyst’s vice president of patient safety products, said in a statement. “Recent evidence continues to demonstrate that the majority of patient harm goes undetected and that medical injury is the third leading cause of death in the US—evidence that challenges voluntary reporting as an effective patient safety management strategy.”
Examining the factors that are most influential in driving organizations’ patient safety efforts, a majority of survey respondents (51 percent) named regulatory reporting as an influencing factor. Coming in second at 39 percent was “financial considerations” such as malpractice claims, value-based contracts and reduced reimbursement. Other choices included published accreditations and designations (34 percent); patient satisfaction scores (33 percent); data-driven organizational priorities (29 percent); performance against safety measures (27 percent); brand recognition, market competition (16 percent); and stakeholder interests (11 percent).
When asked to identify the areas where patient safety most needs improvement, survey takers rated four of the six choices within 3 points of each other. “Inpatient clinical” areas of focus such as length-of-stay, mortality and readmissions came out on top at 21.6 percent, barely ahead of “operations” (21.1 percent), an area that includes ED wait times and patient instructions at discharge. Two other areas most in need of improvement, according to survey takers, were “severity of illness” (19.5 percent), “outpatient/ambulatory clinical” (18.6 percent).
Only “regulatory reporting,” including reporting of hospital-acquired conditions, seemed to require slightly less improvement than other areas, with 15.5 percent of respondents citing it.
“The big picture takeaway from this survey is that although a small portion of respondents felt they have a good handle on their patient safety efforts, the largest portion of respondents still believe that they have room for improvement,” Valere Lemon, R.N., a senior subject matter expert for Health Catalyst, said in a statement. “Surveilling all-cause harm will aid healthcare organizations in bridging the gap from niche focused improvements to proactive harm identification and broader patient safety improvement interventions.”