The Evolution of Healthcare – Patient Safety
Insights from healthcare leaders at Patient Safety – The COVID-19 Virtual Edition
The Evolution of Healthcare – Patient Safety
Insights from healthcare leaders at Patient Safety – The COVID-19 Virtual Edition
<small><small><span class="rightalign">With the support of <br>Headline Partner:</small></small>
‘Embracing the new normal – repositioning patient safety in the era of COVID-19’
The recently concluded Patient Safety – The COVID-19 Virtual Edition, organised by Informa Markets, brought together multiple disciplines relating to patient safety, healthcare epidemiology, public health, risk management and infection control and prevention, virtually.
The theme of the event was ‘Embracing the new normal – repositioning patient safety in the era of COVID-19’, and it connected a global audience to healthcare leaders and practitioners worldwide who shared their best practices about driving patient safety in the new normal.
In this report titled 'The Evolution of Healthcare – Patient Safety,' we dive deep into the different conference sessions at the event and highlight how COVID-19 has impacted the various facets of patient safety such as the expedited role of technology and Artificial Intelligence (AI) in patient safety, the importance of quality and accreditation, and effective practices in CSSD, among others.
The report has been produced in association Malaffi, one of the key initiatives of the Department of Health – Abu Dhabi (DOH). As the region’s first Health Information Exchange (HIE) platform, Malaffi allows providers from across Abu Dhabi to electronically, safely and securely exchange and access crucial patient information accessible in real-time.
What according to you are the most common causes of medical errors?
- Medication error
- Infected medical equipment
Atif Al Braiki, CEO, Abu Dhabi Health Data Services, sheds light on Malaffi’s role below.
How is Malaffi committed to patient safety?
Malaffi, as the region’s first health information exchange, and a strategic initiative of the Department of Health Abu Dhabi, safely and securely connects public and private healthcare providers across the Emirate. Currently, Malaffi is on its way to connecting 95% of all hospitals in Abu Dhabi and covers 87% of all episodes within the Emirate.
There are already 241 million unique clinical records in Malaffi, collated from any medical interaction a patient has, including information about allergies, laboratory tests, radiology reports, previous diagnosis, procedures and more. Our plan is to expand the scope of information that is contributed by healthcare providers, which will further increase the clinical value of the available information.
Providing instant access to over 33,000 end-users currently, Malaffi increases patient safety by reducing potential diagnostic and treatment errors. It is thought that up to 18% of patient safety errors and as many as 70% of adverse drug reactions could be eliminated if the right information about the right patient, was made available.
The impact of these issues is apparent, which is why events like the Patient Safety event by Informa Markets, proudly supported by Malaffi, is such an important platform. Every year it enables advocates of patient safety to come together, collaborate and explore innovative solutions to current challenges, as well as highlighting the intrinsic need to make safety a global health priority.
Atif Al Braiki
How do you see patient safety evolving?
In recent months, the pandemic has resulted in an accelerated digital transformation within healthcare, on a global scale. In many ways, this has been facilitated by the ability to connect different sources of healthcare information and create databases that provide meaningful insights. This is helping to address patient safety in many positive ways.
Here in Abu Dhabi, the availability of real-time data throughout the pandemic has allowed the Department of Health to strengthen its response. With technology supporting the more efficient allocation of resources, better capacity planning and utilisation, we have felt truly safe.
Furthermore, Malaffi has enabled all vaccine data to be centralised, supporting the Department of Heath’s efficient digital vaccination programme. This has contributed to the UAE’s ambition to have half of its people vaccinated by March.
Malaffi has enabled all vaccine data to be centralised
Looking ahead, Malaffi is paving the way for the introduction of AI and machine learning technologies to further improve care coordination and public health management. Efforts are also underway to launch an app to give patients access to their Malaffi file, which will empower them to better engage in managing their health.
Creating an “army of first preventers”
While we continue to manage through the COVID-19 pandemic, it is important to reflect on the lessons learned. The response to COVID-19 has shown us that organisations with a commitment to-and competence in- quality, patient safety and accreditation are better prepared to effectively manage a crisis. Published reports from around the globe continue to demonstrate the value of quality, safety and accreditation, providing a framework to guide healthcare facilities as they recover and rebuild. The pandemic is turning out to be a catalyst for innovation, to move into the next generation of quality and safety.
Instead of first responders, we should be speaking to our first preventers.
Prof. David Nash
During the height of the pandemic, some of the hospitals in the U.S. were using an incident command structure, which is essentially an emergency structure that has several important themes built into it. This includes a daily or a huddle multiple times a day, where all the leaders get on a call together to talk about how things are going.
“One of the components of the structure is issuing regular guidelines for care, as they are important in day-to-day quality and safety to improve performance. Evaluation, feedback, closure of the feedback loop, all of these things are very relevant to the quality and safety agenda,” said Prof. David Nash, founding dean emeritus of the Jefferson College of Population Health (JCPH) of Thomas Jefferson University and the Dr Raymond C. and Doris N. Grandon Professor of Health Policy, Philadelphia, U.S. Dr Nash has been named as one of the Most Powerful Persons in Modern Healthcare and has also received wide acclaim for his COVID-19 thought leadership.
He highlighted that in the U.S. there has been some evidence of diffusion of an incident command culture, post-COVID-19. This means that things that worked can be carried over in non-emergency situations as well to improve patient outcomes.
Another trend that COVID-19 has brought about is the growth in integrated delivery systems and hospital mergers across the globe. “Many hospitals suffered terrible economic losses and layoffs,” said Dr Nash. “It’s ironic that in the middle of a public health emergency, hospitals were laying off people. As a result of the financial strain, we’re going to see weaker hospitals join larger systems. But this does not guarantee that quality and safety will improve.”
Furthermore, he stressed that there needs to be a recognition of the social determinants of health, factors that have affected society the most in the COVID-19 era and have had a huge impact on health. This is especially true for poor countries that might not have the resources to tackle the pandemic.
“The impact of COVID-19 can’t just be determined by tests and laboratory results. It has to do more with poverty, lack of education, crime, drug abuse, depression, and loneliness, among other factors. Global recognition of the social determinants of health is paramount,” he added.
Dr Nash also touched upon the struggle between public health and the healthcare system: “When public health is working, we don’t pay any attention to it. This refers to access to clean water, the air is clean, people have vaccines for all the previous infectious diseases, so public health operates quietly in the background. But it’s severely underfunded. For example, the national U.S. healthcare spending per person is roughly US$10,000 per person, including children annually, while total public health spending per person in the U.S., in 2019, was US$275.
"That’s why it is no surprise that the public health system got crushed by COVID-19. It failed because it was destined to as it was so severely underfunded and under-appreciated. We are now hoping for a convergence of the public health and healthcare system in the post-COVID world.”
Dr Nash has been an advocate of creating an “army of first preventers”, people who work in the community and are focused on prevention. “It means we should focus on preventing illness rather than always taking care of people after they’re sick. The focus should always be on prevention. So, instead of first responders, we should be speaking to our first preventers,” he explained.
|Goal One – Identify patients correctly
|Goal Two – Improve effective communication
|Goal Three – Improve the safety of high-alert medications
|Goal Four – Ensure safe surgery
|Goal Five – Reduce the risk of healthcare-associated infections
|Goal Six – Reduce the risk of patient harm resulting from falls
The contact tracing dilemma
Dr Nash also spoke about contact tracing and how most people hadn’t heard of it until the pandemic.
“Contact tracing is a proven technology and a well-established basic tool for improving public health. Unfortunately, the U.S. was totally unprepared to do contact tracing,” he stressed. “People had not been trained, and most people were scared of it, as it seemed too intrusive.”
He gave the example of China, where one of the reasons for their success was the contact tracing carried out through smartphones. An average Chinese citizen would be tracked and photographed every day, which citizens in the U.S. would never tolerate. “We would view it as a totalitarian state. On the other hand, it’s a very successful tool for isolation and quarantine. Do you want your freedom, or do you want to stop COVID-19? It’s a culture clash."
Global recognition of the social determinants of health is paramount
The emergence of data-driven patient safety
Keeping patients safe is intrinsic to the work of healthcare professionals. It is at the core of all that the healthcare community strives to achieve, but unfortunately, modern medicine still sometimes falls short. There are identified gaps in the way patient information is recorded, with fragmented and “siloed” information. But, thankfully, as technology plays an ever-increasing role in healthcare, it is helping to keep patients safe.
According to Dr Rahul Goyal, Senior Vice President of Clinical Engagement, Malaffi, as data-driven patient safety emerges, there is access to better tools, to achieve better patient outcomes.
He said: “As demonstrated globally, Health Information Exchange (HIE) platforms allow healthcare professionals to safely and securely share a patient’s most important medical information, digitally. The technology allows us, as care providers, to securely share information in a way that was not possible before. The introduction of Malaffi is a strategic effort by the Department of Health Abu Dhabi towards a digital transformation of the healthcare ecosystem and is helping to further improve the quality of healthcare services and ensure patients’ safety.
"Knowledge really is power and by filling in inconsistencies in information, I can make better-informed decisions, which ultimately puts safety first.”
It is thought that up to 18 per cent of patient safety errors and as many as 70 per cent of adverse drug reactions could be eliminated if the right information, about the right patient, was made available.
With the use of HIEs, this is possible. It also prevents unnecessary and repetitive diagnostic tests by presenting relevant recent results to all clinicians involved in patient care, hence reducing the exposure to radiation (scans etc.) and other invasive procedures.
HIEs empower both the patient and the provider. Patients can be confident that the most informed decisions are being made about their care, based on accurate information from their individual health journey and avoid preventable errors.
18 per cent of patient safety errors and as many as 70 per cent of adverse drug reactions could be eliminated if the right information, about the right patient, was made available
“I have had patients say ‘Dr, I’ve seen my endocrinologist, you must have the results. Tell me what’s next. This is a fantastic attitude for patients to have,” said Dr Goyal. “This transparency makes sure we both invest in their safety, right from the start.
"As a doctor, I often got a very fragmented view of a patient care summary. There are gaps and grey areas. But HIEs provide a credible, holistic view, in an organised format.
"They give a comprehensive picture of my patient’s history, even if they have been seen outside of my network. By filling the gaps, it gives us detailed information on critical information, and this helps ensure safety is at the forefront of all my clinical practice.”
Another big technology trend that saw wide adoption due to the pandemic was Telemedicine. It is a big new market that can greatly help in diagnosing medical conditions as well as treating mental health, as there is an acute shortage of mental health workers globally, said Dr Nash.
“During the pandemic, there was a real exponential increase in people accessing telehealth. It is a big business now, which was pretty sleepy before the pandemic.
"The impact of AI on patient safety has also come into the spotlight as it helps in reducing the burden of healthcare professionals by managing patient flow. It supports an early response to the pandemic by enabling efficient patient monitoring, screening and decision-making for the prevention of large-scale community spread."
While we need the collection and analysis of the data, we also need actionable items from it. You need to get information from the data. The tools to derive actionable information include AI and predictive analytics."
Prof David Nash
Dr Samer Ellahham, Regional Chair, Middle East Patient Safety Movement Foundation; Director, Accreditation; Cardiology Consultant, Cleveland Clinic Care Giver, Cleveland Clinic Abu Dhabi, explained that AI’s practicable algorithms provide updated information to all individuals about positive cases in their vicinity as well as probable sites of infection and virus influx around. A clear description of cases helps in local awareness, health education and information allowing individuals to take necessary precautionary methods.
He added that well-trained AI models are also useful in providing insights into the disease and drug treatment, which are not yet understood by practitioners. A useful discovery made with the help of deep learning algorithms is that patients may continue to spread the disease even after their efficient recovery because diagnostic tests were found to be positive 5-13 days after treatment.
The use of AI helps in enhancing patient safety due to the early identification of complications and their logical management. He cautioned that a limitation includes the lack of clinical trials demonstrating the safety of the use of AI in COVID-19 positive cases. This limits its use in diagnostic and treatment-related roles.
For Kathryn K. Leonhardt, MD, MPH, CPPS, CPHQ, Joint Commission International Principal Consultant, International Quality & Patient Safety, Wisconsin, U.S, with the digital transformation we are all experiencing through the expansion of technology, the next generation of quality – Quality 4.0 – has arrived for healthcare, as it has for other industries. COVID-19 has reinforced the criticality of quality and the need to incorporate technology, including the use of available data sources and advanced analytics.
The literature on Quality 4.0 focuses on understanding and managing context when approaching a problem: leadership, culture, diversity, adoption and implementation. The quality professional needs both technical skills as well as the ‘soft’ skills of change management, communication and teamwork.
Quality 4.0 – has arrived for healthcare, as it has for other industries
Implementing effective processes
When responding to disasters, organisations need to prioritise safety and reduce risks of harm. COVID-19 made very visible the risks to both patients and healthcare workers from communicable diseases. A September 2020 World Health Organization (WHO) report identified that 14 per cent of COVID-19 cases are amongst healthcare workers, as high as 35 per cent in some countries. Hospitals with effective procedures for infection prevention and control were able to pivot their attention toward managing this novel virus.
Dr Leonhardt highlighted that emergency management frameworks are based on the cycle of PREPARE, RESPOND, RECOVER and MITIGATE. Health systems that applied quality improvement and patient safety principles managed successfully through each of these phases.
For example, during the prepare phase, the use of prioritisation matrices such as the hazard vulnerability analysis provides a systematic approach to plan for potential hazards. South Korea illustrated this by using the lessons learned from their experience with MERS in 2015, implementing updated emergency plans when COVID-19 arrived.
By applying quality tools such as listening to the voice of the customer (patients and staff), conducting root cause analyses, collecting data, implementing corrective actions, organisations can improve their processes to be more effective.
According to the WHO, one in 10 patients are harmed while admitted to hospitals. Now is the time for a cultural transformation across the globe, to move healthcare toward high reliability and zero patient harm.
Joint Commission has studied high reliability in healthcare and identified three pillars:
• Leadership that is committed to safety, setting the strategy and providing resources;
• Organisational culture focused on safety – for patients and healthcare workers – as the priority;
• Performance Improvement, a data-driven approach to problem-solving, with all staff trained in the science of improvement
Central Sterile Services Department (CSSD)
Focus on quality control
The pandemic has increased the health and safety awareness of the healthcare staff and put an increased focus on infection control, PPEs, decontamination of N95s, donning and doffing, and ensuring that proven validated biocidal detergents/disinfectants are in use.
Recently, there have been numerous reports highlighting how ultrasound transducers have different pathogens on them and can potentially cause patients to get infected.
While discussing the ‘Importance of high-level disinfection for ultrasound probe’, Robert De Jong, RDMS, RVT, FAIUM, FSDMS. Owner & Independent Consultant, Bob DeJong, LLC, Baltimore, Maryland, U.S., said: “There are a couple of articles that have already shown issues with ultrasound contaminating patients, and the research is still ongoing. We still have a long way to go to understand how ultrasound could potentially be causing harm to patients.”
De Jong stressed that one of the tenets of patient safety is making sure all of the equipment is properly disinfected. “Unfortunately, in some instances, people rush and don’t do the disinfection process thoroughly,” he said.
“That leaves our next patient open to getting infected. As healthcare workers, we have to make sure we’re protecting ourselves and our patients, by washing our hands properly. I think if we had taken the disinfection process more seriously, then COVID-19 might not have spread as quickly. We need to take a step back and say, I know it takes extra time, but we have to do that to protect our patients, ourselves and our families.”
When it comes to disinfecting ultrasound equipment, he highlighted that when scanning through intact skin and if the patient doesn’t have a surgical post-op wound or open sores, low-level disinfection can be done.
However, if the transducer touches body fluids or mucous membranes, then high-level disinfection would need to be carried out even if a transducer cover was used.
I am a firm believer that all transducers whenever possible should receive high-level disinfection because this stuff lasts for weeks on surfaces. We can’t continue to wipe the transducer with a cloth thinking we did a good job, when, in fact, we didn’t follow the instructions properly."
Robert De Jong
Some of the technological advancements in sterile processing over the last few years include software traceability, barcoding, and aligning real-time equipment data to track and trace.
If the transducer touches body fluids or mucous membranes, then high-level disinfection would need to be carried out even if a transducer cover was used
Some others include validation on equipment, challenging and monitoring equipment; how to reduce and eliminate risks, develop controlled ISO 8 Cleanrooms where inspection and packaging tasks are carried out and revalidation of Cleanrooms; and quarterly Environmental Monitoring where reusable medical devices are exposed to the environment.
When asked if technology could help in making ultrasound safer, he shared the example of a device available in the market today that uses sophisticated hydrogen peroxide to disinfect. It allows you to put the transducer into a cabinet, press the button and seven minutes later you’ve got a high-level disinfected transducer.
The important thing about this device is that it also disinfects the handle, which can be contaminated and is often neglected.
He concluded: “I think the ultrasound community needs to start taking disinfection more seriously. There are still some factions that don’t believe they are infecting their patients and are still doing low-level disinfection when they ideally should be carrying out high-level disinfection.”
According to Geraldine McNulty, MSc, Decontamination Lead/Medical Device & ISO 13485:2016 Hospital Representative, Kings College Hospital, Dubai Hills, the future of the CSSD, would involve more intricate medical devices, for example, robotic surgery, and the importance of creating and maintaining Medical Device Files for each device, incorporating pictorials of the device, pictorials of tray assembly, IFUs, on-going training and competencies.
“CSSDs are becoming more like a manufacturing plant with strict controls and monitoring in place. I encourage every CSSD department to strive for the Gold Standard ISO 13485:2016 and achieve it,” she added.
CSSD is often referred to as a hospital's...
- Circulatory system
- Central nervous system
- Immune system
COVID-19 has exposed strengths yet revealed weaknesses within healthcare systems globally. Changes that have been in development for decades, such as telehealth, were accelerated in implementation. But failures in the system – such as social inequalities, healthcare insurance coverage gaps, lack of single-source data centres – have been accentuated. It is time to reframe quality, safety and accreditation.
When asked about how the post-COVID-19 world should look like, Dr Nash concluded: “We need better leadership; people who can put their ego aside and stimulate teams. We need people who are optimistic about the future, despite the challenges. We need leaders who can look beyond the immediate situation and have a long-term vision.
“I hope that we can have better international cooperation to fight the next pandemic, which will inevitably occur. I am hoping for improved communication and cooperation and better preparedness. We will also see a greater interest in public health.”
While Dr Goyal said: “Looking at the bigger picture, I see huge opportunities for HIEs to improve patient safety further and to support health management of the community. Never before have we had access to credible, reliable, clinical data, on such a large scale. I would like to see the UAE develop chronic condition registers. By monitoring certain criteria for every patient that we see, we can not only improve outcomes but ensure that the DoH can focus their resources on areas that really need improvement. It allows a better picture of public health to be formed. With credible data, we can strategise accurately for the health and safety of our community.”
The Evolution of Healthcare – Patient Safety is the latest report in a series looking at the latest trends shaping healthcare, based on opinions voiced by healthcare leaders at Informa Markets’ Healthcare events.
Prevalent insights on value-based healthcare were drawn by an expert Informa Markets team from commentary during Patient Safety Exhibition – The COVID-19 Virtual Edition, an event brought by the organisers of Arab Health, Africa Health and FIME.
From 5-7 November 2020, Patient Safety Officers, Infection Control Managers, CSSD Technicians, and Nurses from across the globe participated at the event and discussed key topics impacting patient safety. The commentary from these sessions was analysed and distilled to form the key insights shared in this report.
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- Audio (podcast)
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