Changes in Medical Errors after Implementation of a Handoff Program

From the New England Journal of Medicine (hat tip: Dr. Menadue):

BACKGROUND

Miscommunications are a leading cause of serious medical errors. Data from multicenter studies assessing programs designed to improve handoff of information about patient care are lacking.

METHODS

We conducted a prospective intervention study of a resident handoff-improvement program in nine hospitals, measuring rates of medical errors, preventable adverse events, and miscommunications, as well as resident workflow. The intervention included a mnemonic to standardize oral and written handoffs, handoff and communication training, a faculty development and observation program, and a sustainability campaign. Error rates were measured through active surveillance. Handoffs were assessed by means of evaluation of printed handoff documents and audio recordings. Workflow was assessed through time–motion observations. The primary outcome had two components: medical errors and preventable adverse events.

RESULTS

In 10,740 patient admissions, the medical-error rate decreased by 23% from the preintervention period to the postintervention period (24.5 vs. 18.8 per 100 admissions, P<0.001), and the rate of preventable adverse events decreased by 30% (4.7 vs. 3.3 events per 100 admissions, P<0.001). The rate of nonpreventable adverse events did not change significantly (3.0 and 2.8 events per 100 admissions, P=0.79). Site-level analyses showed significant error reductions at six of nine sites. Across sites, significant increases were observed in the inclusion of all prespecified key elements in written documents and oral communication during handoff (nine written and five oral elements; P<0.001 for all 14 comparisons). There were no significant changes from the preintervention period to the postintervention period in the duration of oral handoffs (2.4 and 2.5 minutes per patient, respectively; P=0.55) or in resident workflow, including patient–family contact and computer time.

CONCLUSIONS

Implementation of the handoff program was associated with reductions in medical errors and in preventable adverse events and with improvements in communication, without a negative effect on workflow. (Funded by the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, and others.)

Ten statistics on the current use of telemedicine in hospitals, health systems

From Becker’s:

Ninety percent of healthcare leaders reported their organizations have begun developing or implementing a telemedicine program, evidencing an industry-wide embrace of technology to achieve improved quality of care for patients and organizational success. According to the 2014 Telemedicine Survey Executive Summary conducted by Foley and Lardner LLP, healthcare leaders have reported a strong commitment to adopting telemedicine programs, even in the face of financial barriers and physician resistance.

The enthusiasm surrounding telemedicine is largely influenced by the shift in financial and payment incentives under the Patient Protection and Affordable Care Act, according to the report. As providers shift away from traditional fee-for-service reimbursement models and begin to take on a greater share of the risk — and possible reward — for producing better patient outcomes, telemedicine offers a new solution for streamlining operations and expanding contact with patients. According to the report, while leaders are confident in the potential of telemedicine, the biggest obstacle they are facing in its implementation is getting the physicians who will be using it on board.

Medical Schools to Replace Curriculum with Year Long course in ICD-10 and E & M Coding

From the incomparable Gomer Blog (humor, obviously):

In a visionary statement, the Deans of ten of this nation’s top medical schools, including four Ivy League Schools announced today that they are replacing their schools’ entire 3rd year curriculum with an intensive year-long course on diagnostic and evaluation and management coding.

He continued, “Moreover, with the explosion of journal articles devoted to this topic and an entire industry of coding consultants developing around it, we realize that our students must master the body of knowledge necessary to become effective and skillful coders and thus deliver top notch care, if not innovators in the field.  We hope that eventually we will also be able to offer fellowships in this discipline.”