Focus
How a hospital can use data from PerfectServe Analytics and customized reports to manage risks, safeguard patients and improve clinical communications.
Managing Risk: Detailed Documentation of Communication Events and Timelines
PerfectServe has eliminated the need for subjective interpretations when St. Rita’s must establish the steps and timeline of a communication process preceding an adverse event. Using PerfectServe Analytics, the hospital can quickly identify and drill into data that shows the specific time each communication event was initiated; the originating department and number; the intended recipient; the actual recipient; the contact modality (e.g., cell phone, voicemail, text message); the length of the call; and, for calls that employ failsafe contact processes, whether and when a specific call was answered by a clinician and the elapsed time to retrieve a voice message.
The hospital uses this data whenever it is investigating cases relating to quality or risk management. In fact, St. Rita’s decided to implement PerfectServe after it was unable to prove that one of its nurses had contacted a physician three times. The lack of documented evidence was a key factor in an unfavorable lawsuit that cost the hospital hundreds of thousands of dollars.
“PerfectServe is our ‘black box’ for communications that lets us piece together exactly what happened and when,” said Dr. Herbert Schumm, St. Rita’s vice president of medical affairs. “Also, our physicians have become conscientious about being responsive, in part because they are aware that we automatically document the communications process.”
Safeguarding Patients: Legibility of Physician Orders
At most hospitals, including St. Rita’s, the vast majority of physician orders are still written by hand. A recent report found that only 14 percent of all U.S. hospitals are entering at least 10 percent of orders electronically—the level of computerized physician order entry (CPOE) required to reach the federal government’s proposed standard for Stage 1 of meaningful use. The legibility of these orders can be a problem that is more pervasive—and more of a threat to patient safety—than most hospitals realize.
In an article in Trustee magazine*, a Joint Commission executive notes that his agency “almost always finds instances where handwriting is of poor quality.” According to the Agency for Healthcare Research and Quality, poor penmanship is responsible for an estimated six percent of all hospital medication errors.
To address this issue, St. Rita’s used PerfectServe to document and measure incidents of illegible handwriting. For defined periods of time, PerfectServe prompted callers to indicate when they were calling to clarify an illegible order. The system captured data on where the order was received and who wrote it. PerfectServe compiled this information into reports for the Patient Safety Steering Committee.
“We sat down with about four or five doctors and showed them the number of calls that were made to clarify their orders,” said Dr. Schumm. “We also reminded them to use pre-printed order sets whenever possible.”
The analysis showed that, during the first three months of the study, an average of more than 80 calls per week were made to clarify orders. On two subsequent analyses, after discussions with some of the doctors, the average was only 53, a drop of more than 40 percent.
Improving Clinical Communications: Physicians’ Responsiveness
According to the Joint Commission, communications breakdown is the single greatest contributing factor to sentinel events and delays in care in U.S. hospitals. St. Rita’s uses PerfectServe to track a key source for such breakdowns, i.e., physicians who do not respond to calls.
Of the hospital’s approximately 15,000 monthly communication events processed by PerfectServe, about 15 to 25 are directed to the PerfectServe Help Center to report a problem with a physician not responding. Dr. Schumm and the patient safety team use these reports as a way to open a constructive dialogue with physicians whose names repeatedly appear on this list.
“It really helps to have such clear, objective evidence for the physicians,” said Dr. Schumm. “Most of the time, showing them the reports is enough to prevent future incidents.”
Since PerfectServe collects communications process information automatically, nurses do not have to “tattle” on doctors who do not always respond in a timely manner. This not only relieves nurses of an uncomfortable task, but also enables St. Rita’s to avoid adversarial situations that can undermine physician-nurse relationships.
*Glabman, Maureen. “Death by Handwriting,” Trustee magazine, October 2005.