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21st-century hospital system to increase patient safety

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How can medicine make the next big leap to raise the level of safety in the treatment of patients? Marion J. Ball, professor at Johns Hopkins School of Nursing and fellow at IBM Research’s Center for Health Care Management, presented her answer to this question during the University of Pittsburgh’s Science 2008 showcase last week. She believes the next big leap ahead will come from a patient-care culture of heightened vigilance in which nurses can work in a more empowered environment while information technology enables use of more complete and timely communication to support the patient.

Despite tremendous advances in medical technology, with new and improved medical billing companies offering their services, as well as a focus on medical AI’s, Ball sees fragmentation in the present system of communication that addresses a patient’s health in clinics and hospitals. She noted that medical errors account for some 7,000 deaths and 1.5 million injuries per year, figures that may be understated by a factor of 20 and fail to capture millions of near misses.

Significant progress against these dangers in places where people go to recover their health calls for a change in consciousness as well as clinical procedures enabled by communication, information technology, and a culture of vigilance. At the heart of the change, she said, are the 3-million nurses who represent 55 percent of U.S. health care workers. Their roles need to be strengthened at the front line of patient care.

The integration and accessibility of patient health histories at the location of treatment is a key part of this solution, she said. Patient data, including full treatment histories, behavioral, genetic, and personal profiles, need to be available to enable caregivers to make the best choices, she argued.

As an example of innovation that begins to address these issues, Ball cited the University of Pittsburgh Medical Center’s “Smart Rooms.” The project has equipped 6 rooms at UPMC Shadyside with computer screens that, in addition to patient vital signs, can also display medication and other personal records, identify specific patient conditions for nursing staff, provide reminders to patients to request assistance, identify clinical personnel for the patient, and help in other ways to increase the dialogue between patient and medical personnel. The hospital plans to expand to 24 Smart Rooms next year. UPMC is developing smart rooms as one of several U.S. medical centers involved in a program called Transforming Care at the Bedside.

Ball also criticized continued reliance on paper-based transactions, noting as an example that medication errors decrease by 55 percent when machine-readable forms replace doctors’ handwritten prescriptions.

Acknowledging skepticism toward increased centralization of patient records, Ball recalled the history of the introduction of the stethoscope for diagnosis of patient health at the end of the 18th century. That simple instrument revolutionized the ability of doctors to analyze the condition of an individual’s health by careful listening to sounds inside the body. Integration of information technology into a new culture of communication and vigilance can produced an equivalent gain in patient care in the 21st century, Bell said.

Source: Marion J. Ball, EdD
Writer: Joseph Plummer

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