“Do no harm” is seen as the central tenet and prime directive of an oath traditionally taken by physicians since the time of Hippocrates (c. 400 BC). Though this precise phrase is not found in the oldest extant Greek copy (c. AD 275) of the so-called Hippocratic Oath, that copy does contain a phrase of similar sentiment: “I will abstain from all intentional wrong-doing and harm.” While not universally accepted today, over half of modern doctors still bind themselves to some version of this oath. Indeed, modified versions of the oath have found their way into codified law within some jurisdictions.
Regardless of its origin and irrespective of its legal status, the Hippocratic Oath remains as the lodestar and the keystone upon which all of medicine is fixed. With that in mind, it would seem to behoove those engaged in the profession of healing to proactively remove—to the extent reasonable—every identified risk to patients’ health during a care episode and/or hospital stay.
Such risks, when actualized, become known as adverse events—a fall, a fever, an unforeseen complication that further compromises the patient’s condition or overall health. It is the task of both the clinical staff and the facility to ensure that the rate of adverse events is continually reduced. This is not only for the purpose of abiding by the ancient prime directive but also to ensure that the hospital maintains a positive standing in the eyes of the public. There is nothing more damaging to a facility’s reputation than getting only one out of five stars on the social media apps. Patients fill out satisfaction surveys. These become transparent, which means that potential customers are going to know which hospital in town has the worst record for patient safety and outcomes.
THE RISK IS REAL
The New England Journal of Medicine recently published a study that points to a significant incidence of adverse events in hospitals, generally. In a random sample of 2809 admissions, researchers identified at least one adverse event in 23.6 percent of admissions. Among these 978 adverse events, 222 (22.7 percent) were judged to be preventable and 316 (32.3 percent) had a severity level of serious (caused harm that resulted in substantial intervention or prolonged recovery) or higher.
The study concluded with the following summation:
Adverse events were identified in nearly one in four admissions, and approximately one fourth of the events were preventable. These findings underscore the importance of patient safety and the need for continuing improvement.
So, the risk to patients who enter your facility is all too real. Ensuring that the “do no harm” mantra is followed with consistent vigilance, therefore, becomes all the more critical. Now, with the help of technology, that job has just become easier.
SEEKING SOLUTIONS
According to a March 12 Wall Street Journal report—as recounted by Becker’s Hospital Review—modern technology is being used in some hospitals to address and further reduce four specific adverse events. Accordingly, the report encourages hospitals to consider incorporating these four strategies to strengthen their patient safety efforts:
- Medication Mistakes. Issuing incorrect medications or dosages remains as among the most common causes of adverse events. To combat this, several hospital systems are using artificial intelligence (AI) to identify patterns in medication reporting, logging, etc., in an effort to detect errors. The system can also “notify clinicians of potential harm in real time by, for example, catching changes in lab results that show a medication may be causing harm to the kidney.”
- Patient Falls. Enhancing patient education coupled with technology can reduce the rate of adverse events. For example, Brigham and Women’s Hospital in Boston developed a program to identify a patient’s risk of falling in 2007 and later worked with a New York hospital system to further enhance it. Now, nurses calculate fall risk for each patient and take appropriate preventative actions, like moving medication lower or scheduling bathroom breaks. They also display fall risk warnings for the patients to see and have seen fewer falls as a result.
- Surgical Mistakes. Tools, such as the patient risk calculator developed by the American College of Surgeons or the University of Florida’s AI-powered system called MySurgeryRisk, aim to better prepare surgeons and predict which patients might need more specialized care or who could be at higher risk for complications related to surgery.
- Stopping Infections. Implementing use of a quality and safety dashboard that works with electronic medical records (EMRs) can act to alert clinicians in real time concerning issues that may need to be addressed to prevent infections, such as for central lines and urinary catheters.
According to the previously-referenced New England Journal of Medicine study, nearly 25 percent of all adverse events are preventable, but this will require medical institutions to take increasing advantage of the strategies and technologies that are available to assist in the “do no harm” directive. Protocols must be put in place and training must occur to enhance the efficacy of the care being provided by hospital staff and clinicians with hospital privileges. An aggressive and focused effort on the part of all in avoiding these adverse events will help the hospital’s reputation, improve patient outcomes and create a boost in staff morale. It’s just the thing that would cause an ancient Greek physician to smile.
Justin Vaughn, MDiv, serves as vice president of anesthesia compliance for Coronis Health. Mr. Vaughn has over 20 years of experience in anesthesia compliance and has been a speaker at multiple national healthcare events. He has written two books on compliance-related issues and is the author of numerous articles relevant to the hospital space. Justin can be reached at Justin.Vaughn@coronishealth.com.