Using Portable Digital Technology for Clinical Care and Critical Incidents: A New Model
Bolsin, Stephen N., Faunce, Tom, Colson, Mark, Australian Health Review
The number of patients suffering adverse incidents during treatment in hospitals is not declining. The cost of this poor safety record in Australia is $1 billion to $4.7 billion each year. Quality and safety initiatives focus on promoting adverse event reporting. Major problems include poor reporting of adverse events and lack of clinician involvement.
We propose a model for clinician-led reporting based on secure transmission of encrypted data from a programmed personal digital assistant (PDA) to a secure database, leading to automated analysis of clinician-performance data. The programmed PDA also facilitates the reporting of critical incidents. All critical incidents are automatically fed back by email to the organisational quality managers.
Aust Health Rev 2005: 29(3): 297-305
The problem in health care
The available evidence suggests that the percentage of hospitalised patients suffering an adverse incident during admission is not declining.1-5 Major inquiries into publicised revelations of substandard health care performance continue to find one of the major contributing factors is an institutional and professional culture opposed to self-reporting and open disclosure.6-10 The costs of this continuing poor safety record run to billions of dollars in most developed societies.1,5,11 Current quality and safety initiatives focus on promoting adverse or sentinel incident reporting to institutional committees seeking to discover contributory causes and implement corrective strategies 1,2,13 Unfortunately, poor individual reporting rates for adverse events in health care and inadequate clinician involvement in the related processes continue.1,14-18 This is despite other industries, such as aviation and environmental resource management, making considerable progress in this area.19,20
The adoption of sustained health care quality improvement programs is similarly poor despite the fact that numerous authors have documented the benefits of such programmes to improved patient outcomes.21-23 There is a clear need for routine performance monitoring by all clinicians. This will involve clinicians, or their specialist associations or Colleges, in approving and sanctioning the collection and analysis of routine performance data.23-25 The available evidence seems to suggest patchy commitment to such data collection on individual clinical performance, and also to incident reporting, for a variety of reasons.23,26-28
Medical practitioners in all practice areas are currently accorded professional status from society and government, with the attendant privileges, in return for ensuring consistently high standards of practice.29,30 When self-regulation fails, as it did in the Bristol Royal Infirmary, The Winnipeg, The Canberra, and the King Edward Memorial hospitals, or the Harold Shipman case, then many in society tend to lose trust in the profession and government is pressured to increase external regulation or ensure adequate self-regulation.9,29-36 Exposure of high levels of safety breaches and poor quality in health care, though a necessary antidote to inefficient quality and safety processes, raises the public anxiety about medical self-regulation.6 If self-regulation is to be preserved, the profession and government must act to ensure an effective commitment to high quality and safe health care provision.29
Such considerations also arise from the current significant and increasing costs of medical indemnity in Australia, which has some parallels in the United Kingdom.4,37,38 These increased indemnity costs may in part be related to an unsustainable level of adverse events in Australian health care,2 of which more than one third were attributable to a failure or complication of a technical procedure.3
Some UK studies suggest that failure to report adverse events arises at least partly from a culture in the medical profession that does not support the open or confidential disclosure of poor safety or performance. …