Printer-friendly format

Eric Schwartz, MD

Patient safety is always of paramount concern in a practice or facility, but with new compliance protocols and other federal and state mandates, the issue is taking on increased importance.

While many are scrambling to put processes and procedures into place, the Holston Medical Group is already well ahead of the curve. It created the Academy of Patient Safety (APS) in 2005 and has been custom-tailoring its approach to the issue ever since.

What the academy does, in sum, is create channels of communication between all members of a patient-care team, then combines that with computerized medical records. The combination of a multidisciplinary dialogue and everyone having simultaneous access to records means fewer mistakes in patient care, says Eric Schwartz, MD, who joined the Holston Medical Group in August 1997. Schwartz, a hospitalist, serves as medical director of Holston's hospital team as well as director of APS, which he says is revolutionary in that it blends human interaction with computerized patient care, reducing duplication and other errors all along the way.

"APS integrates the entire group; that's the beauty of electronic records," Schwartz said. "The nuts and bolts of what we do is in the hospital, so that's where we have to have enhanced communication using multidisciplinary rounds. A key component to that communication is recognizing what we're trying to accomplish, getting everyone to understand what our goals are."

In other words, when the nurses are doing their rounds, the physicians should know what's going on, as should the respiratory therapist, case manager, physical therapist, anybody and everybody on the patient's treatment team. APS makes that happen, drawing in everyone from the dieticians to the hospital chaplain.

"When everyone can tap into the records and see what everyone else is accomplishing, it truly becomes a multidisciplinary approach," Schwartz said. "The end goal is coordination of care."

In addition to the mobility of electronic records between all the interested parties, the APS also works by encouraging nurses and other team members to question treatment protocols based on their observations, as well as raise concerns they might have. This is done during two daily, multidisciplinary grand rounds, the second led by a nurse, as well as ongoing input and dialogue between team members.

"In the past you'd get one page from a nurse saying a patient is asking about the X-ray, or whether the specialist will see him or her today," Schwartz said. "That's inefficient from a patient-care perspective, because the nurse has to stop what they're doing to take down the information, then the doctor has to stop in order to read it and answer the patient's concern. By coordinating and consolidating this process, there's less chance of incorporating errors into the process, plus it empowers every team member."

Since its inception, APS has shown itself not only to be effective in terms of patient management, but it's also cut down on staff time spent reviewing cases. According to the Holston group's data, APS responsibilities take between 60 and 90 minutes daily, compared to upwards of four hours for similar programs and efforts.

And best of all, APS doesn't stop when the patient is discharged; its final act is the electronic transfer of all patient information to the primary-care physicians, ensuring a seamless transition from hospital to home care.

From its inception to now, APS has been answering concerns that were brought up in a 1999 report from the Institute of Medicine that called for a national effort to reverse medical errors and improve patient safety. That call has become more urgent with the October 2008 introduction of "do not pay" rules by the Center for Medicare and Medicaid Services that will penalize what are deemed preventable hospital-safety errors such as catheter-caused urinary tract infections and injuries from falls.

"Of course, it's most important to give patients the best care for the sake of the patient, but what we've been doing for years before 'do not pay' became a reality is addressing issues like Foley catheter usage," Schwartz said. "We began looking at how long they needed to be in place, and the quickest mechanism for getting them out. We've also been looking at a lot of other issues, like blood clots in surgical patients and risks for medical patients with complex issues, so that we could address them through APS. We've been profoundly proactive in this regard."

APS has had some strong numbers showing the efficacy of its approach. According to the Holston group, APS has reduced the risk of cardiac arrest; dropped catheter use by one full day, which in turn reduced the risk of urinary tract infections; and has surpassed Medicare's core measurement requirement in areas including smoking-cessation and heart-failure education.

And those numbers, as well as a very active buy-in from doctors and hospital staff, have led to the program's first round of expansion outside the Holston Valley Medical Center.

"We have wanted to expand our project to other areas and to other hospitals, but we've had some obstacles to overcome," Schwartz said. "But now we're in the preliminary stages of trying to incorporate this at Indian Path Medical Center. The APS stands on its own as an excellent program, and we think it will work in any hospital regardless of size. It can be incorporated into any environment very successfully."

Tags:

None

Login and voice your opinion!

Do you know someone else who would like to see this?
Your Email:
Their Email:
Comment:	(Will be included with e-mail)