Profession

Online tool helps assess safety procedures

The new patient-safety survey is free, but practices must pay $200 to find out how their scores compare with other groups.

By Kevin B. O’Reilly — Posted March 5, 2007

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Three big names in health care are promoting a new assessment tool they say can help physician practices determine how well they are managing crucial areas where gaps in care can harm patients and increase medical liability exposure.

The Medical Group Management Assn., the Institute for Safe Medication Practices, and the Health Research and Educational Trust collaborated to create the Physician Practice Patient Safety Assessment and piloted the tool with 200 practices before making it widely available last fall.

The 80-question assessment was developed with the help of an expert panel of 18 physicians, pharmacists and quality experts. It covers medication safety, handoffs and patient transitions, surgery and invasive procedures, personnel qualifications and competency, patient education and communication, and practice management and culture.

"Many errors are preventable if proper patient safety-centered procedures are used throughout the continuum of care, including in physician practices," said Terry Hammons, MD, an MGMA senior fellow.

A study released by medical liability insurer ProMutual Group last year found that diagnostic errors accounted for nearly 40% of closed claims analyzed in seven specialties between 2002 and 2004. Experts attribute most of those errors to problems with missed follow-ups and delayed lab reports. Using the new assessment to identify that and other problems, the experts say, could reduce the risk of harm to patients and the risk of lawsuits to physicians.

The assessment sets out an objective -- for example, "A complete medication history including over-the-counter medications, vitamins and herbal products is obtained and documented on every patient during each office visit" -- and asks practices to identify on a scale from A (no activity) to E (fully implemented in all areas) how far along they are in implementing the safety practice.

The survey can be downloaded for free, but to find out how they stack up against other practices on a national percentile basis, groups must pay $200 and enter their responses to the questionnaire online. The fee also pays for a workbook to help practices change in the areas they identified as needing improvement. No individual practice's scores or data will be released publicly.

It took a multidisciplinary team at one 11-physician cardiology group with seven locations in the Southeast four hours to complete the assessment, but the group's chief executive said it was worthwhile.

"There were many things that, as we went through the survey, had been there all along, but we didn't realize it," said the practice CEO. "We had these 'Gee, I could have had a V8' moments. It gave us a chance to sit down and do some soul-searching."

A new electronic prescribing system that the group already had decided to implement was "the answer to about 95% of our questions," the CEO said, but added that the assessment helped focus the group on how to track lab results more accurately and reduce practice variations across its sites.

The groups that created the assessment tool are in talks with medical liability insurers to spread the word to physicians and perhaps offer financial incentives to practices to participate. They also have received inquiries from medical and specialty societies and several large groups with 10 to 12 practices.

Bruce Bagley, MD, director of quality improvement at the American Academy of Family Physicians, reviewed the assessment tool and said he had not seen other surveys, such as one made available through the National Committee for Quality Assurance, go into such detail about potential gaps in care.

"Anything that causes a practice or an organization to be introspective with regard to these kinds of issues will be helpful," he said. "The hard part will be getting people engaged."

Dr. Bagley added that the survey lacked details about how much it would cost practices to participate and to implement the changes recommended in the survey, whose evidence base ranges in strength from item to item.

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ADDITIONAL INFORMATION

Falling through the cracks

The Physician Practice Patient Safety Assessment features 80 questions that cover areas where gaps in care can harm patients, such as medication safety, handoffs and patient communication. Below are examples of how often things go wrong:

For every 1,000 ...

  • Women with a marginally abnormal mammogram, 360 do not receive appropriate follow-up care.
  • Referrals for consultation, 250 referring physicians do not receive follow-up information within a month.
  • Outpatients taking a prescription drug, 90 seek medical attention because of drug complications.
  • Prescriptions written, 40 contain medical errors.

Source: Eric G. Poon, MD, MPH, physician researcher in the Clinical Informatics Research and Development Group at Partners HealthCare System in Boston

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Evaluating safety

Practices using the Physician Practice Patient Safety Assessment tool are asked to mark how well they've implemented each recommendation on a scale from A (no activity) to E (fully implemented). Here are examples of items covered:

Medications: Patients are provided with an up-to-date list of all medications they are receiving upon leaving the practice or encounter (e.g., on a convenient wallet reference card).

Handoffs and transitions: The practice maintains a process to communicate all medications (name, dose, frequency, route and purpose) that a patient is receiving when admitted to a hospital, nursing home, home care agency, rehabilitation center, etc.

Surgery, anesthesia and sedation, invasive procedures: The site of any surgical or invasive procedure to be performed for each patient is confirmed and documented by two staff members and the patient before the procedure starts.

Personnel, qualifications and competency: The practice maintains a system to provide continuing education to clinical and support personnel that is both specific and appropriate for the level of services provided in the practice.

Practice management and culture: A system of reporting errors, such as incident reports, is in place and is supported by a culture of safety that allows for open collection and sharing of data within the practice.

Patient education and communication: Patients are assessed for their financial and physical ability to obtain prescriptions and medical supplies at the time of their office visit or when provided a prescription over the phone.

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External links

The Physician Practice Patient Safety Assessment (link)

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