Patient Safety, Quality of Care, and Value PDF

Patient Safety, Quality of Care, and Value Intro to Profession Amanda Stevenson-Cali Block One  Lecture Objectives Explain the standard of care Identify general principles of patient safety Evaluate quality improvement strategies Compare adve...

Patient Safety, Quality of Care, and Value Intro to Profession Amanda Stevenson-Cali Block One  Lecture Objectives Explain the standard of care Identify general principles of patient safety Evaluate quality improvement strategies Compare adverse events, errors, and omissions that result in patient harm Explore risk management  Introduction to Quality of Care Standard of care Medical errors Patient safety Quality of care Value-based care Standard of Care: Definition: In legal terms, the level at which the average, prudent provider in a given community would practice Legality: If a provider fails to provide ”standard of care,” that provider is subject to errors/omission malpractice. We will learn these ”standards” as we move into core curriculum Medical Errors and Adverse Events - Hippocrates (2000 BCE): “First do no harm.” - Define - Medical Errors: Preventable adverse events either committed by COMMISSION (active harm: Malfeasance) or OMISSION (passive harm: Negligence). - Adverse Events: Nonpreventable cause of harm resulting from treatment or natural disease course Why we are talking about this… To Err is Human - Study in 1999: about 44K to 98K patients die each year from medical errors (NAM) - Led to aggressive restructuring of patient safety protocols - James Reason (psychologist) - “Swiss cheese model” - Shows institutional paradigms contribute to medical mistakes. Sole responsibility does not always lie with the provider but can also lie with the institution  THIS IS IMPORTANT “Swiss cheese” diagram. Reason argues that most accidents occur when a series of “latent failures” are present in a system and happen to line up in a given instance, resulting in an accident. Examples of latent failures in the case of a fall might be that the unit is unusually busy and the floor happens to be wet. (Adapted from J Reason: BMJ 320:768, 2000; with permission.) Source: The Safety and Quality of Health Care, Harrison's Principles of Internal Medicine, 19e Citation: Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. Harrison's Principles of Internal Medicine, 19e; 2015 Available at: http://accessmedicine.mhmedical.com/content.aspx?bookid=1130&sectionid=66487336 Accessed: February 11, 2018 Copyright © 2018 McGraw-Hill Education. All rights reserved  Types of Medical Errors – Medication Errors Dosing, scheduling, contraindications, toxicity – Surgical Errors Wrong-site surgery, technical error, anesthesia complications – Diagnostic Errors Delayed treatment, wrong treatment, worsening conditions – Handoff Errors When patients change providers or services (shift changes) – Iatrogenic Infections Hospital or healthcare associated infections - Example of Error vs Adverse Event (Preventable vs Non-preventable) - A) Proper antibiotic dosing in pneumonia leads to renal failure (adverse event or “side effect”) - B) Improper antibiotic given to a patient with pneumonia, that leads to renal failure (error) Preventing Medical Errors and Adverse Events Global Trigger Tool: One way to monitor, measure, and classify errors CPOE: Computerized Physician Order Entry (EPIC, Centricity, GE, etc) - One study showed 55% reduction in adverse events/errors just by having the CPOE in play - Just keep in mind: - Morbidity and Mortality conferences are designed for education against and information on adverse events - As patients age, the likelihood of an adverse event occurring also rises - Not all errors lead to a bad outcome or harm to a patient BUT about 10% of admissions have an adverse event and nearly half of those do cause actual harm - Most hospitals and practices employ these rules: - 1) Errors can be made by competent providers trying their best - 2) Systems should be designed to prevent these errors before they happen (EHRs (electronic health record) and CPOEs) - 3) Strategies should be developed to grow along side the ever-increasing complexities of healthcare delivery systems  Risk Management – Division of healthcare focused on designing practices and systems that help reduce errors and adverse events to improve patient care – Discuss this in terms of two main systems: Double Check Systems Forced Functions  Double Check Systems – Designed to reduce errors in routine behaviors (slips in otherwise habitual medical practice behaviors) – Two ways: 1. Built in redundancies – Reading back orders verbally 2. Cross checks – Signing surgical site; asking patients for name/DOB before giving medication Forced Functions – Person-machine interface technology that won’t let things move forward if there is an error – The best example (outside of medicine): Try to put your car in reverse without your foot on the brake… - Introduction to Quality of Care - Math: - Value of care = Quality/cost - As quality increases, Value increases - As cost decreases, value increases - Why does this matter? - New CMS guidelines reward providers (“bonuses”) for hitting certain standards of care marks - Not a perfect system – leads to a “provider report card” and “provider transparency” - “No pay for errors" Quality of Care - Six Aims for Quality Care - 1. Care must be safe - 2. Care must be effective - 3. Care must be patient-centered - 4. Care must be timely - 5. Care must be efficient - 6. Care must be equitable  Theory of Quality of Care Structure – If quality care is available (e.g. on-site cath lab or MRI) Process – The way care is delivered (e.g. Pap smears at correct intervals) Outcome – What actually happens to the patient  What happens if … ? – 1. Patient presents to a hospital with chest pain and suspected AMI. – 2. Hospital has on-site cath lab and patient given aspirin at correct time. Treatment delivered fully and timely – 3. Patient expires from severe infarction anyway  How to Improve Quality Treatment centers (offices and hospitals) undergo continuous quality improvement Currently ~50% patients receive actual quality care (RAND corp) – Patients were flipping a coin as to whether they got standard treatments Development of Quality Tools  Conclusion Goal is to provide standard of care to all patients in all situations Reduce medical errors by using a system-down approach Patient safety is probably the most important goal Constantly strive to improve quality by self-study and improvement tools Value of care is based on reducing costs while improving outcomes