Supporting Safer Healthcare

How much important information is locked away from those who need it in your organization?  And how much added expense and potential patient harm does that create, at a time when national efforts are focused on eliminating both?

Because of legitimate concerns related to privacy and confidentiality, hospital leadership allows, and even encourages, protecting sensitive information.  However, that action often creates the unintended consequence of hiding valuable data behind locked doors. 

Let’s consider the case of Dr. Z, a General Surgeon on the staff of Mythical Hospital.

The Quality Management Department has identified a trend related to Dr. Z’s practice, a pattern of unexpected post-operative complications causing an increased length of stay. Depending on hospital policies, that trend may be reported to a Department Chair, a Quality Committee, etc.  The information may also be placed in a file to be reviewed every two years at the time of the physician’s reappointment to the medical staff.

Infection Control has also detected a trend in Dr. Z’s patients.  Part of the reason they have a longer than average length of stay is that they have a higher than average post-operative infection rate.  Depending on hospital policies, that trend may be reported to the Department Chair, an Infection Control Committee, etc.

The Patient Advocate’s Office, which handles patient complaints, has received several regarding the way Dr. Z talks to patients and families. The Advocates have worked hard to develop good service-recovery techniques and have done their best to re-engage Dr. Z’s disgruntled patients.  They have also reported the trend in their monthly reports to hospital administration, and they know that the CEO has spoken personally to Dr. Z regarding improving his communication skills.   

Speaking of complaints, Nursing Leadership has received a few from the surgical nursing staff regarding Dr. Z’s demeaning attitude toward them in the OR.  The Perioperative Surgical Director has spoken to Dr. Z about the matter, and believes that there has been some improvement.

The Medical Records Review Committee has sent two letters to Dr. Z in the past year regarding his documentation practices.  While Dr. Z does complete his records in a timely fashion, the documentation is often sloppy, contains unapproved abbreviations, and even some inappropriate remarks about other members of the staff.  The issue remains on their agenda for further review.

Enter Risk Management, which is called in to investigate a post-op complication resulting in serious harm to one of Dr. Z’s patients.  During their investigation Risk discovers that the surgery took far longer than expected, there was injury to surrounding tissue, possibly due to poor surgical technique, and that the family is very unhappy and intends to file a lawsuit against both the physician and the hospital. The Risk Management files are protected by attorney-client privilege, and are reviewed by the hospital’s legal counsel. 

Two years have passed and it’s time for Dr. Z’s appointment and privileges to be reviewed.  The Medical Staff Office gathers information to assure that Dr. Z’s credentials are up-to-date and that he remains in good standing with the State licensing board, etc.  A query is made to the National Practitioner Data Bank, which reveals no new settlements or disciplinary actions over the past two years.  The physician’s quality file is pulled and given to the Department Chair to review.  The Department Chair again sees the data regarding Dr. Z’s post-op complication trend and extended length of stay.  He notes the issue in his comments, and adds that he has personally spoken with Dr. Z about the matter.  However, he doesn’t feel it warrants a recommendation for non-reappointment to the staff, and so recommends that Dr. Z’s appointment and privileges continue as requested. 

Everyone at Mythical Hospital is working hard to do the right thing to protect patients and the organization.  They also don’t want to unnecessarily harm the reputation of a staff physician.  But none of them have the whole picture.  So how can the problem of the missing pieces be solved? 

With appropriate technology support, the information can then be compiled and combined with Ongoing Professional Practice Evaluation (OPPE) and Focused Professional Practice Evaluation (FPPE) data and (frequently) reported through the Department Chair, the Credentials Committee, the Medical Executive Committee and finally in summary to the Board, which has the ultimate responsibility for appointing and reappointing members of the medical staff. 

There must be a central repository for all data related to a physician’s practice.  The logical repository is the Medical Staff Services Department.

Because Dr. Z practices in nearly every hospital.