Proactive clinical surveillance tools are the second big step in creating a safety net for patients. With patient data in electronic form, hands-on caregivers, nurses, and supervisors can use specially designed “dashboard views” to quickly identify which patients are exhibiting warning signs of clinical decline and exactly where they are located.
To be most effective, staff should view clinical surveillance information in a variety of useful ways:
- Hospital–wide for a big picture of where the trouble spots are
- By unit, to scan through patients and see the values that are triggering an alert
- By provider, so doctors and nurses can scan their list of patients and see which have triggered alerts
- By patient, drilling into all the details of that patient’s current status and previous care
- By patient, drilling into all the details of that patient’s current status and previous care
tion, which are out of range or trending in the wrong direction, should automatically highlight patients. With the complete clinical record on-line, staff can prioritize which patients to visit next and what type of supplemental resources might be needed to enhance care.
For hospitalists, clinical surveillance tools save an immense amount of time and help prioritize patient care. Typically hospitalists manage a large number of patients who are scattered around the hospital. Determining where to start rounds and which patients should be seen first is often difficult. Even worse, patients’ conditions suddenly change for the worse soon after you’ve checked on them. There are just too many patients to continually be looking at patient charts and relying on verbal information: that’s why there are computers!
Supervisory staff can provide an additional safety net, if they have the tools to do so effectively. Typically, they rely on “report” and walking around, visiting staff, looking for an opportunity where their intervention could be helpful. By referring to “hot spots” indicated on a clinical surveillance dashboard view, they would know where they’re needed and spend their time helping, rather than prospecting.
Some hospitals have formalized their response to the failure to rescue problem by creating “rapid response teams.” Such teams can also rely on clinical surveillance tools to identify patients in need, rather than waiting for a phone call from an overwhelmed primary caregiver.
FIGURE 2. Clinical surveillance information may be seen in “dashboard views” by unit or provider, to scan through patients and see values that triggered an alert.
Making Best Practices Work
Organizational performance can be dramatically improved when patient outcomes and staff activity can be measured and analyzed. Traditionally, this has been done retrospectively.
By evaluating outcomes of patients and compliance with processes, many sites have been able to improve processes for future patients. However, because reporting has been periodic, results become available only months later, and implementation of care enhancements are delayed.
With comprehensive patient data in electronic form, real-time monitoring of compliance with intended processes and best practices becomes possible. For example, if there is a consensus that the head of the bed of ventilated patients should be elevated to reduce the incidence of ventilator-associated pneumonia, then the monitoring system can show, by ICU, the percentage compliance with that protocol at any given moment.
Since the report is available real-time, non-compliance can be addressed immediately, benefiting the patient and directing education about the protocol precisely when and where it is needed for maximum impact.
Creating a Reliable Patient Safety System
An electronic medical record forms the very foundation of a patient safety system. This electronic data provides the capability for proactive clinical monitoring and much more sophisticated process analysis that happens in days or weeks, not over a course of months or years.