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Weekly UpdatesIn conclusion, we believe this study provides healthcare managers with important evidence regarding the relationship between IT adoption and patient safety in hospitals. The nature of returns associated with IT investments is multifaceted. Managers must consider both financial and clinical impacts that stem from IT adoption decisions. We hope that with a clearer understanding of how IT may relate to important patient outcomes, hospital leaders will be able to make better-informed decisions and to offer their patients better quality care.
PRACTITIONER APPLICATION
Karen Pietrodangelo, R.N., executive director of quality management, Tallahassee Memorial HealthCare, Tallahassee, Florida
At Tallahassee Memorial HealthCare, we are frequently concerned with the impact that investments in information technology (IT) will have on patient safety. Even though several studies have been published suggesting that IT is associated with improved outcomes, it seems that most studies have been conducted in an academic medical center, where the operational environment is very different from the environment in community hospitals. This article by Menachemi and colleagues is a welcome addition to the patient safety literature because it is more applicable to the typical hospital.
The patient safety committee at our hospital frequently considers the Agency for Healthcare Research and Quality's Patient Safety Indicators (PSIs) when examining trends in the hospital's performance. We have considered various IT solutions when we were dissatisfied with trends on a given indicator. One of the difficult questions posed by members of the patient safety committee is, "How do we know that investing in a new IT system will have a measurable impact on our patient safety outcomes?" Until now, we have typically assumed, and hoped, that our well-intentioned and expensive investments would pay off. The study by Menachemi and colleagues has demonstrated that significant differences in performance on the PSIs exist, and some of these differences can be explained by the level of IT systems in place at hospitals.
The concept of reducing reliance on vigilance by "hardwiring" solutions and overcoming barriers was originally described by James Reason, who spoke of the "Swiss cheese" model of system accidents. In his widely cited book, Human Error, Dr. Reason suggested that many errors occur because barriers designed to avoid errors are porous. These imperfect barriers can include human variables such as attention span, ability to focus in crises, fatigue, and technical knowledge.
When IT systems are thoughtfully selected and properly implemented, vulnerability to human fallibility can be mitigated. For example, in transfusion medicine, the use of bar-coding technology when collecting blood samples and labeling blood types has reduced reported errors, from 1 in 3,000 (when relying on human-driven processes) to 1 in 3,000,000 (when the process is automated). In addition, integrated IT systems--including computerized physician order entry, laboratory results reporting, pharmacy systems with alerts for drug interactions and allergies, and "smart pumps" for infusion therapy--all provide additional hardwired barriers that can improve patient safety. Given these relationships, the findings of this study are not surprising; hospitals that have adopted IT systems in an effort to reduce the barriers that prevent optimal care are performing better on the PSIs. Studies like this one are very valuable when considering difficult decisions about IT investments.
References
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