Knowledge to Practice observes Patient Safety Awareness Week 2020

Background

Mark Chassin, MD, FACP, MPP, MPH, president and CEO, The Joint Commission, was a member of the IOM’s Committee on Quality of Health Care in America, which wrote To Err is Human: Building a Safer Health System in 1999. In November 2019, Dr. Chassin reflected on the accomplishments of the past 20 years and emphasized the importance of the leaders of healthcare organizations to commit to “zero harm” in these 2 ways:

Creating an organizational culture of safety

Leaders of healthcare systems and hospitals are encouraged to create a culture in which (1) all staff feel empowered to speak up and raise concerns and safety and quality of care and (2) all staff are held accountable for 100% adherence to safety protocols and best practices.

In observance of Patient Safety Awareness Week, K2P spoke to four professional leaders who play different roles in patient safety. 

Ashish Khanna MD, FCCP, FCCMWe spoke to Ashish Khanna MD, FCCP, FCCM, Associate Professor, Section Head for Research, Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest School of Medicine

What are the largest patient safety challenges facing you and your colleagues in the critical care units across the US?

The biggest challenge, in my opinion, is the appropriate use of all the information generated from every single patient, processing all these signals and then using them in an appropriate manner to ensure patient benefit and prevent the occurrence of critical events. Not only are there new and more portable ICU monitors that are generating continuous streams of ventilatory and hemodynamic data, there are also new and more sophisticated imaging modalities and new invasive devices which are used in organ support. The critically ill patient is a gigantic computer with many gigabytes of data; this system is evolving and expanding at a very rapid pace. The human brain (of the treating intensivist, nurse, and other providers) finds it hard to keep pace with and process data to ensure optimal patient outcomes. In part, the overload we are feeling is related alarm fatigue, but it is also simply the capacity of the human brain to identify subtle changes in physiology, labs, imaging, and connect all of these dots to apply back to the patient in question.

What are the additional challenges facing hospitalists and nurses who staff the general medical and surgical units?  

One element that separates the general medical/surgical units from the ICU is the intensity of monitoring/patient surveillance. Not only is the nurse/patient ratio different, patients outside of the ICU are not continuously monitored. We know that adverse events in hospitalized patients are typically preceded by a prolonged period of gradual change in vital signs- these can be missed with the lack of continuous monitoring- thus precluding the prevention of critical events.

What can you tell me about the ABCDEF bundle?  

Also called the ICU Liberation Bundle, the ABCDEF bundle elements can help reduce delirium, improve pain management and reduce long-term consequences for adult ICU patients. 

  • A = assess, prevent and manage pain
  • B = spontaneous breathing trial and spontaneous awakening trial
  • C = choice of analgesia and sedation
  • D = delirium: assess, prevent and manage
  • E = early mobility and exercise
  • F = family engagement and empowerment. 

While these 6 elements are truly intuitive things that should be incorporated on a daily basis for every ICU patient, the creation of an easy to use “bundle” allows ICU practitioners to remember to use these on a daily basis. During ICU rounds I often ask my resident or fellow to review the bundle for every patient he or she presents. We have found that we have often uncovered a lot of missing daily care and or medical management issues by actually reciting the elements of the bundle. 

I know you recently participated in the Society of Critical Care Medicine (SCCM) meeting. What compelling information about patient safety was presented/discussed at this meeting?

The SCCM meeting this year focused on big data, and embraced the artificial intelligence and big data revolution in critical care medicine. There was actually an inaugural “datathon” pre-conference that convened data scientists, machine learning experts and clinician-scientists under one roof. Critical care is an environment that is naturally conducive to the generation of multiple pieces of data and I am glad that time and resources are being invested to train all of us on how to best handle this information overload. The SCCM has now established, a computational critical care workgroup within the DISCOVERY research network and also established a knowledge education group (KEG) focused on machine learning, where interested individuals such as myself are leading efforts across the organization in promoting the growth of this avenue in terms of education and clinical practice. 

How can we, whose mission is lifelong learning for the practicing clinician, support national patient safety efforts?

K2P can serve a key role in the support of national patient safety efforts. The emerging sources of new data available to the critical care provider needs to be understood in the context of evidence-based medicine. There is so much literature that is being published every day that it is nearly impossible for the busy clinician to keep current. K2P has the expertise to provide a ready and easily accessible portal that collates new information and translates it into relevant clinical case studies and best practice scenarios, using engaging web-based interactive learning. The lifelong learning model used by K2P can provide immense benefit to a dynamic specialty like critical care.