We live and work in a chaotic world, which makes prioritizing, organizing and being vigilant ever-more valuable functions. Carrying out these feats requires commitment, though.
Take Excela Health in Greenburg, Pa., for example. The hospital chose to undergo review by the Accreditation for Cardiovascular Excellence (ACE) as part of a rebuilding effort after a few cardiologists appeared to be inappropriately stenting some patients. As part of the process, the EHR system for the cardiac catheterization lab was scrutinized and analyzed for shortcomings such as missing information. Proper documenting of appropriateness is a weakness among many facilities seeking accreditation, according to ACE.
Howard P. Grill, MD, medical director of the cardiac cath lab at Excela Health, said in an interview that the review helped them identify opportunities to improve. For instance, they found that they captured critical data but failed to make it readily accessible. A physician may have obtained fractional flow reserve results that helped justify a clinical decision, but the results were buried within the record. Their solution was to consolidate important data and place them prominently in the EHR.
Oklahoma Heart Hospital in Oklahoma City also made an effort to get information to caregivers in a straightforward and timely way with its mobile patient monitoring platform. The provider took into account what nurses wanted: accessible information; alerts based on specific requirements; visual indicator, room and waveform; automated escalation capabilities if an alert wasn't responded to in 15 to 30 seconds; and speed and reliability.
Oklahoma Heart settled on a platform that uses Nurses Caring Blackberries that send real-time critical alerts with pertinent information, said Steve Miller, CIO at Oklahoma Heart, at the 2012 annual conference of AAMI, the Association for the Advancement of Medical Instrumentation. “When a patient has an event, the device captures critical alarms and routes it to the Blackberry, which occurs in less than one second,” he said. Log data are used to generate reports for review and follow-up.
However, not every solution hinges on technology. A recent study found that circulating nurses in cardiovascular operating rooms prevented or corrected on average 11.11 medical errors per procedure. By and large the errors were by individuals, with only 5 percent attributed to systems and organizations. Most errors were potential mistakes that were prevented or intercepted and others were stopped before the patient was harmed.
Tools such as EHRs and Blackberries facilitate care and may even compensate for some human error. But nurses deserve a lot of credit, too. These kinds of observational and problem-solving skills often go unrecognized and only their absence draws attention.
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Cardiovascular Business, editor