It Should Be Easy To Do the Right Thing (part 3)

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Making Amends: In Search of a Solution 

As mentioned in part one and two of this series, The Doctors Company conducted a study on their malpractice claims. In the article, they provide strategies to help with patient communication and reduction of potential errors.

  1. Ensure effective handoff procedures during hospitalization and at discharge.
  2. Communicate with everyone involved in the patient’s care, including patient, family, prior-treating physician, and patient care team members.
  3. Document your plan and rationale, including any changes in plan. Be sure to document patient noncompliance. Use quotes for patient comments related to noncompliance.
  4. Evaluate the need for physical examination when notified of a change in an inpatient’s condition. If in doubt, go see the patient for a bedside evaluation. 
  5. Always consider a differential diagnosis early in treatment.
  6. Follow up on all laboratory tests and procedure reports. Review test and lab results that were not available prior to patient discharge. Ensure notification of primary care physician and patient of abnormal results after discharge.
  7. Do not delay consultations or testing. Be careful relying on curb side consultation and always consider asking the specialist to examine and evaluate the patient.
  8. Ask for a second opinion. Advanced practice practitioners should consult supervising physician if needed.
  9. Documentation is your silent witness: Document clearly and completely in the patient medical record, with appropriate abbreviations used in the facility.  
  10. Review the medical record thoroughly, including emergency room records. Understand facility EHR protocols and where to find information in the EHR. 

These recommendations are great, but they strike me as being quite nebulous and still incredibly dependent on the clinician remembering to do something, or write something, or check something.  The problem, as we discussed previously, is that the cognitive load on clinicians is so high, that mistakes happen! What we need to do is provide tools to either obviate the need for us to “remember” things, or to make it easy for us to do the right thing at the point of care.

 Hindsight easily spots how the swiss cheese model fails us and errors happen.  However, in real time, clinicians have to manage a herculean volume of information, much of which is critical to correct diagnosis and treatment. 

Safe care hinges on the successful surfacing, gathering, and transferring of information among multiple clinicians across multiple settings. In order to help clinicians keep pace with all of those demands and maintain patient safety, EHRs and clinical communication policies and the health IT system provided, should be developed with a commitment to having the right information in the right hands at the right time, with easier, team-based  workflows. 

In other words, it should be easy to do the right thing. 

Better processes + better platforms = better patient care. 

If you’re looking for solutions built around optimizing workflows, reducing variation and errors, check out TrekIT. 

Incorporating best practices around team based communication, handoffs and usability, TrekIT is bringing modern team collaboration technology to healthcare.  All of these workflows, from rounding, to handoffs, to documentation and more are parts of an overall  workflow.  One that has been divided into different steps, systems and procedures as a consequence of poorly designed systems and tools.  

TrekIT is designed to mirror the entire clinical team’s workflow – whether being used by an attending physician, a new intern, a nurse, pharmacist, therapist or social worker, the platform supports team based care, facilitating seamless communication and more complete documentation. Designed by clinicians, for clinicians, TrekIT’s HIPAA compliant, collaborative and patient centred think space, with real time access to critical data from EHRs is transforming how teams work together to provide the highest quality care possible. 

It’s time to throw out all assumptions and shake up our clinical workflow tools to mirror the way we actually provide care today: not in once a day encounters where one person knows everything about a patient.  But rather as a continuum of care, where teams of care partners work to heal our patients and each other. The status quo is just not cutting it any more.