Medical errors are grossly under-reported, with only an estimated 10% safety events ever identified via voluntary reporting systems. There’s an entire line of academic inquiry simply targeted at increasing the proportion of safety events detected, with the overall goal of informing subsequent practice change. This study – mentioned in the daily ACEP News briefing – takes it one step further, attempting to predict future safety events in real-time.
These authors used a continuous stream of data from the electronic health record to create a “patient safety active management” system. They created an initial model based on four years worth of data from 2009-13, and subsequently validated it by pilot implementation at two hospitals between 2014-17. During these pilot phases, each nursing unit was provided with a dashboard for every patient indicating whether a trigger event had occurred, along with a twice-daily updated score of their overall risk for an event. A nurse reviewer followed all the automated positive triggers and evaluated their downstream harms, as well as the harm severity.
We’re a long way from prime time. There were 775,415 trigger events in 147,503 inpatient admissions, resulting in 3,896 clinically validated safety events. The vast majority of events were “temporary harm” or “increased length-of-stay”, although there were a few serious safety events as well. Worse still, these authors don’t specifically delve into “preventable” harms, as their list of most common adverse events do not clearly offer clues as to whether the harms could specifically be mitigated or avoided. For example, many of their harms were medication-related bleeding or medication-related Clostridium difficile infection – unintended harms, to be sure, but frankly known risks of the likely medically-appropriate treatment pathways.
Every project has to start somewhere, of course, and these early steps will hopefully further inform more specific tools. Hopefully – though I’m unfortunately skeptical – I primarily expect more low-value, alert fatigue-inducing hiccups along the way.
“An Electronic Health Record–Based Real-Time Analytics Program For Patient Safety Surveillance And Improvement”
https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2018.0728