Advance care delivery through technology

Abstract

Align information technology initiatives with staff expectations regarding patient safety. Inadequate nurse staffing contributes to approximately 25% of hospital incidents that kill or injure patients, according to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Of the 1,609 adverse events that hospital officials voluntarily reported to JCAHO between January 1996 and March 2002, 24% occurred, in part, because the hospital had an insufficient number of RNs on the job. 1 The Institute of Medicine’s (IOM) Committee on the Quality of Care in America reported that between 44,000 and 98,000 hospital deaths each year are related to medical errors. 2 The IOM identified technology as a viable method of enhancing patient care delivery and improving staff productivity. 3 Data captured from Chief Information Officers (CIO) participating in the Healthcare Information and Management System Society’s (HIMSS) annual leadership survey validates the IOM’s stance. CIOs identify increasing patient safety and reducing medical errors as the top business issues that will impact health care in the next 2 years. 4 The question becomes, how does technology implementation and usage influence the efforts of nurses, physicians, and other clinical staff? Daily practice implications Research suggests that compared to other clinical specialties such as radiology and pharmacy, nurses and physicians are most likely to benefit from technology—mainly through its improvement in patient safety, not a reduction in the amount of time spent on administrative functions. 5 (See “Areas most benefited by technology.”) Specifically, 66% of respondents indicate that patients would benefit from increased use of technology as a result of increased patient safety or reduced medical errors. Conversely, less than 25% believe that technology would either reduce the time spent on clerical functions or increase the amount of time that clinical staff can devote to direct patient care. 6FIGUREFigure: AREAS MOST BENEFITED BY TECHNOLOGYIn the 2003 HIMSS survey, 95% of nurse and physician executives, much like their CIO colleagues, identify patient safety as the area most notably affected by technology. 7 (See “Patient safety issues that technology can address.”) A New England Journal of Medicine report concludes that information technology can reduce the rate of errors by preventing adverse events, facilitating rapid response after they’ve occurred, and providing feedback on these occurrences. The report also proposes specific strategies for improving patient safety through technology, including enhancing communication among clinicians, providing information access, assisting with calculations, “smart monitoring,” decision support, and medication management. 8 Smart monitoring involves using monitors that have built-in intelligence, such as alerts and reminders, rather than just data-collection capability.FIGUREFigure: PATIENT SAFETY ISSUES THAT TECHNOLOGY CAN ADDRESSInitiating change Clinicians, notably nurses, play a critical role in patient safety initiatives. Nineteen percent of respondents to the HIMSS survey identify Chief Nurse Executives and Patient Safety Officers as the leaders of their facilities’ patient safety initiatives. Further, among the 89% of survey respondents working at facilities with patient safety committees, 95% indicate that at least one nurse sits on the committee. Overall, 97% of patient safety committees have representation from either a nurse or physician. 9 But surprisingly, we’re only beginning to tap the potential of information systems in health care. Consider this: The use of computerized patient records has increased by less than 10% in the past 5 years. 10 Emerging technologies that impact patient safety include biometrics, barcoding for medication administration, handheld wireless devices, small form factor Web applications (to enable use of clinical information systems via personal digital assistants), multimedia capabi