Building a Culture of Safety
In the 10-plus years since the inaugural publication of the Institute of Medicine (IOM) study on medical error, To Err Is Human, there has been surprisingly little progress in reducing the rate of medical error, despite the adoption of technologies specifically intended to combat medical errors. A growing number of people attribute this lack of progress to fundamental flaws in the American healthcare culture that prevent success.
Safety Huddles for a Culture of Safety
When the Institute of Medicine (IOM) published To Err Is Human: Building a Safer Health System in 2000, the executives and quality and patient safety staff at Gundersen Lutheran immediately started discussions around issues emphasized in the report.
Common Cause Analysis
To improve medication safety, many healthcare systems implement a technology (such as barcode at point of care) or a best practice (such as double-check of high-risk medications). This approach turns performance improvement into experimentation with other people’s solutions for other people’s system problems — the assumption being all providers share the same system problems.
Post-Discharge Call Programs
Improving Satisfaction and Safety
For patients coming home from the hospital after surgery, an emergency department (ED) visit or any other inpatient stay, the change in location has both positive and negative possibilities. On one hand, because the patient is returning to familiar surroundings and routines, recovery may be easier. On the other hand, it may be harder.
The National Patient Safety Foundation has awarded grants totaling
$200,000 to support new research in patient safety. The grants will
fund projects led by Elizabeth Cox, MD, PhD, of the University of
Wisconsin School of Medicine and Public Health, and by Gordon Schiff,
MD, of Brigham and Women’s Hospital/Harvard Medical School.
Real-time Locating System (RTLS) from Versus Technology, Inc. for emergency department real-time patient flow
management across its Church and Finch Street locations in Weston and
Downsview, Ontario. Between the two locations, HRRH operates
approximately 550 in-patient beds.
Forerun, Inc., announced a collaboration agreement with Emergency
Medicine Physicians (EMP) Ltd. to develop a physician-focused
documentation system for emergency departments (EDs) nationwide that
are staffed by physicians of EMP and Emergency Physicians Medical Group
(EPMG). Forerun is a clinically-focused healthcare IT company that builds and
hosts custom designed solutions to improve the patient experience,
quality of care and economics of emergency care for hospitals. EMP is a
leading provider of emergency medical services for healthcare
organizations throughout the U.S.
satisfaction scores are considerably lower over the months of January,
February and March. According to Press Ganey Associates, a major factor
for the decline in patient satisfaction is because of the “winter