Improving Healthcare in a Typical

¶ … Improving Healthcare in a Typical Tertiary Healthcare Facility Initiative No. 1. Use Existing Hospital Information System for Patient Incident Reporting for JCAHO Quality Assurance Tracking Purposes. Description. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has already mandated that all accredited healthcare facilities have in place a means of tracking patient incidents such as falls, patient abuse, and medication errors and to provide a means of implementing corrective action when deficiencies are identified (Bryan & O'Connell 23).

Although our hospital does in fact have such a patient incident reporting system in place, it is a highly labor-intensive paper form-based approach that requires copying and hand-delivery to the Office of Quality Assurance; furthermore, this paper-based system is easily transferable to the existing hospital-wide information system intranet. In this regard, the proposed online replacement should replicate the existing patient incident reporting system as closely as possible to ensure staff acceptance of this alternative (Auerbach, Beckerman, Cohen, Goldstein, Quitkin & Rock 134). Potential Benefits.

The transfer of the existing paper-based patient incident reporting system to the existing hospital-wide information system would allow all hospital staff members to file such a report at their earliest opportunity while the events are still fresh in their minds. This approach would also eliminate the need for reproduction of forms for internal distribution since the information would be readily available through the intranet. In addition, assuming that Initiative No.

3 below is adopted, this information could be incorporated into the bi-weekly quality assurance report that is disseminated to all medical center services. According to Warner, Beth Israel uses this approach with their online database, called CareWeb, which contains records for more than 9 million patients. A computerized system automates orders for all prescriptions, lab tests, and IV drips; further, clinician requests are checked against patient data to ensure there are no drug interactions or allergies involved.

Thereafter, all clinician requests are automatically routed to the pharmacy or lab -- and the results to date have been very impressive: "Illegible prescriptions, the bane of pharmacists everywhere, are a thing of the past," the author emphasizes. "So are many medication-related errors, which have dropped 50% since the system was installed in 2001" (Warner 87).

In fact, a number of healthcare organizations across the country have already started using their it systems to reduce their error rates in lab work (Manyika & Nevens 19) and to improve their ability to monitor adverse drug reactions (Andrus, Herndon, Kelley & Murphy 30). The importance of this initiative cannot be understated, both from an accreditation perspective but more importantly a quality of patient care perspective. According to a 1999 report from the Institute of Medicine, somewhere between 44,000 and 98,000 Americans die each year due to preventable medical errors.

Based on these figures, more Americans die in a given year as a result of medical errors than from motor vehicle accidents (43,458), breast cancer (42,297) or AIDS (16,516).

Furthermore, total national costs (lost income, lost household production, disability and health care costs) of medical errors that result in injury are estimated to be between $17 billion and $29 billion, of which health care costs represent more than 50%; in addition, the increased hospital costs of preventable medication-related errors to patients alone are estimated to be about $2 billion for the nation as a whole (Bryan & O'Connell 24). Initiative No. 2. Installation of Hospital-Wide Patient Records Database. Description.

The medical center's existing hospital information system should be used to make patient medical records available to all clinicians who need them. Potential Benefits. According to Dujat, Haux, Schmucker and Winter, the large numbers of inpatients and outpatients treated in a typical tertiary care hospital results in enormous amounts of medical documentation and an increasing number of medical documents. "Due to legal regulations, these medical records have to be stored for 30 years," they advise, and "This implies spatial, organizational, and economical problems.

At present, conventional archiving in hospitals often does not satisfy the need to make medical records available for health-care professionals in a systematic and timely manner" (Dujat et al. 97). Like many other tertiary healthcare organizations, information that is required for a wide range of healthcare applications is already being managed by several autonomous medical information systems including our hospital information system (HIS) (Breant, Taira & Huang 88).

In fact, many healthcare organizations have the technology and infrastructure already in place to realize more benefits from their it investments; however, some of these have failed to integrate their existing technology in a purposeful way (Manyika & Nevens 18). Furthermore, the healthcare industry in the U.S. In general, and this medical center in particular, have heavily invested in it based on the belief that it represented a key strategic factor to improving patient care and reducing costs. In fact, hospitals in the U.S.

were estimated to have invested more than $75 billion a year by the end of 2004 (Chadra, Knickrehm & Miller 91). Unfortunately, our medical center has failed to take advantage of the extensive patient medical records database in place in our Medical Records Service; however, this facility is not alone in this regard. According to Warner (2004), "Most hospitals don't have computer systems that let doctors instantly view a patient's past records, saving life-or-death seconds...

Some 80% of hospitals and 95% of doctor's offices use the same methods for storing and accessing patient data that they did 50 years ago -- which is to say, sheets of paper and film buried in huge metal cabinets" (85). Information systems, though, can vastly improve the collection, storage, retrieval, use, analysis, and dissemination of patient records, test results, and a wide range of clinical encounters (Alpert 302).

One medical center to adopt this approach in a major way was Kansas Spine Hospital in Wichita, a facility that specializes in neurosurgery, spinal surgery, pain management and radiology. This hospital was also one of the first hospitals in the country to entirely digitalize their inpatients' medical records, including prescriptions and clinical records to x-rays and other radiology images, and make them accessible to authorized personnel through their hospital information system ("Just the right prescription" 24). Initiative No. 3.

Use Existing it Systems to Trend Adverse Patient Incidents for Inclusion in Hospital-Wide Quality Assurance Reports. Description. As noted above, our hospital is already required to maintain records of adverse patient incidents such as falls, medication errors, patient abuse and so forth. Assuming that Initiative No. 1, "Use Existing Hospital Information System for Patient Incident Reporting for JCAHO Quality Assurance Tracking Purposes," this raw data could then be graphically trended to help identify problem areas with specific staff members, shifts, wards or medical services.

This trended data could also be incorporated into the quality assurance reports that are already distributed to all hospital services for their review. Potential Benefits. The adoption of this initiative would provide nursing, pharmacy, radiology, medical records and a number of other supervisors with timely and valuable information concerning how their services are performing in providing quality patient care.

In their book, Information Technology and Organizations: Strategies, Networks, and Integration, Bloomfield, Coombs, Knight and Littler (2000) point out that whatever initiative is undertaken the bottom-line for any healthcare organization must be an improvement in the delivery of healthcare services to the end user: "The care of patients is the ultimate end to which all actions must be seen to be subordinated. Put another way, at the end of the day, whatever decisions are taken they must be represented in terms of a net contribution to the furtherance of patient care" (91).

The current approach to collecting patient incident data does not provide for graphically trended data, but rather provides a narrative only of any corrective actions taken; in fact, there is no method currently available to tie any subsequent peer-review of adverse patient incidents to a specific service, shift, ward or other indicator other than a personal identifier. By trending this raw data, the hospital managers could better identify problem areas before they assumed major proportions and coordinate informed solutions based on actual events rather than guesswork and supposition.

For example, if the chief, Nursing Service, was to determine that the third shift on ward B-3 was experiencing an inordinate number of medication errors, investigation and corrective actions could be taken. Likewise, if a certain patient is experiencing more than, say, two falls in a week, the nursing supervisor would likely want to determine if appropriate precautions are being taken with this patient. Initiative No. 4. Applying Existing Information Systems for Improved Inventory Control. Description.

The hospital's inventory control system is currently automated to some extent; however, this automation is restricted to Purchasing and Procurement Service and does not extend hospital wide, especially to the Pharmacy Service. The simple addition of bar code scanners to appropriate "way-stations" along the internal hospital supply chain would allow real-time tracking and control (Herndeen, Maynard & Thompson 72).

With bar code technology, a hospital assigns a number to every asset to be tracked and uses its information system to generate bar code asset tags encoded with the particular item's asset identification number; the specific number then associates each item to be tracked with its related electronic file that containss information such as the purchase date and cost, the person the equipment is assigned to, its location, the vendor, and any warranties, upgrades, or license agreements (Herdeen et al. 72). This initiative would also relate to Initiative No.

6 discussed further below. Potential Benefits. This approach could even benefit the hospital's Human Resources Service. For example, in their essay, "Determining the Size of the Temporary Workforce - an Inventory Modeling Approach," Harel and Herrer point out that determine the staffing levels at a hospital emergency room on a given night requires a determination of how many nurses and physicians are required as core employees in order to minimize staffing costs.

"Since all periods are alike in terms of demand for human resources and costs," they advise, "the core workforce size is determined at the outset, and there is no reason to change it over time. As the demand fluctuates from period to period we can adjust the workforce level by hiring agency temporary workers" (21).

In this regard, the authors note that a hospital inventory control system can be applied to help identify the optimal staffing levels based on past trends: "Clearly we do not hire enough people for every eventuality because this would be just too expensive. Thus, we might decide to hire less workers, and when the need arises we hire temporary workers" (Harel & Herer 22). Initiative No. 5. Implement Interactive Menu-Processing System for Inpatients. Description.

A hospital's food service frequently represents one of the most important components of the quality of care being received from a patient's perspective; hospitals that have placed an emphasis on providing patients with superior food service have reported excellent results. One hospital that individualized its food service in this manner reported having less food waste and less uneaten food being sent back on the trays. "Patients actually order fewer meals, but they eat more food," Hudgins reports (120).

The hospital's Food Service is currently responsible for the preparation of more than 3,000 inpatient meals a day, and another 500 or so for staff members and visitors. Each inpatient that is scheduled to remain in the hospital through the following day is provided with a menu-selection card by the responsible member of Food Service; these cards are then retrieved and appropriate arrangements made for the next day's meal preparation. This is another highly labor-intensive activity that could be streamlined through information technology.

Instead of the paper menu, patients would select their choices from an on-screen display using their television remote controls. Potential Benefits. This initiative would eliminate the need for Food Service staff members to distribute menu cards and then return to patient rooms to retrieve them. This would not only save this amount of personnel time, but it would eliminate these needless intrusions into patient rooms where family members may be visiting, active treatment protocols underway, or where the patient is simply trying to rest, thereby improving privacy and patient care.

Initiative No. 6. Improve Hospital and Grounds Security by Using it-Based Web Camera Applications. Description. Unfortunately, hospitals in the United States are very dangerous places to work, and violence against staff members and other patients is a commonplace occurrence in many places (Cimini & Muhl 57). Currently, there are a number of areas in the hospital and surrounding grounds that are fairly isolated, particularly after normal hours; there have been numerous reports.