Improving Hospital Safety: A Q&A With Dr. David Westfall Bates

It’s been more than 30 years since the renowned Harvard Medical Practice Study revealed that, in 1984, almost 4% of New York’s hospitalized patients experienced an adverse event, more than one quarter of which were considered due to negligence. A decade after that study was published, the Institute of Medicine issued its watershed report, which estimated that up to 98,000 patients die annually from preventable hospital errors.

Today, despite the efforts of hospital leadership and clinical team members, safety problems continue to plague even the best organizations and their patients. A recent study of 11 Boston-area hospitals found that nearly 1 in 4 patients experienced an adverse event, and of that number, nearly one-quarter of the events were preventable.  

David W. Bates, MD, lead author of the study, recently spoke to VigiLanz about the findings. He said the study results underscore the need for hospitals to pursue standardized approaches to data collection and analyses that improve safety. 

“The rate of adverse events is much too high,” said Dr. Bates, who serves as Medical Director of Clinical and Quality Analysis at Mass General Brigham and as Chief of General Internal Medicine at Brigham and Women’s Hospital. “It’s critical for hospitals to track their safety events. We should be leveraging technology to automate data collection to track trends and, ultimately, streamline workflow to improve the efficiency, quality, and safety.” 

In this Q&A, Dr. Bates shares more about the study findings and discusses how technology can help hospitals overcome key safety barriers.  

The study found that nearly 1 in 4 hospitalized patients experienced harm, and of that number, nearly one-quarter experienced preventable harm. How can clinical surveillance and safety event reporting solutions help hospitals address these issues?

DB: Clinical surveillance is one of the most important tools for making care safer. If you have good clinical surveillance in place, you will know how many adverse events you’re having in key areas. It’s critical for hospitals to track their safety events. It’s been said that if you can’t measure it, you can’t manage it. Without knowing how much harm you have, you can’t do a good job addressing the things that are most important at your institution. 

Healthcare teams also respond very positively when they have access to good data about what’s going on. If team members have a robust sense of what the problem is and what issues are causing it, they can do a much better job in terms of actually putting steps in place to make things better. 

Many hospitals have electronic health records, and many of these solutions include some safety-enhancing tools. How do these built-in tools compare to what’s provided by safety surveillance and/or safety event reporting solutions? 

DB: The safety tools in electronic health records are really not sufficient for tracking harm today. That could change over time, but today, the electronic health record vendors have a lot of issues to deal with, and they haven’t been very good at putting tools in place that enable tracking or interventions that improve safety. 

It’s extremely complicated to build a good surveillance tool to identify things like adverse drug events or hospital acquired infections. The data in and around adverse drug events and infections are really complicated. It takes a lot of time and effort to build out the tools to make it possible to find those sorts of problems routinely.

What should hospital leaders be considering when they are evaluating potential investments in safety enhancing solutions?

DB: It’s pivotal to not only look at how much you’re investing, but to also look at the costs of the harm that you’re creating by not investing. Most organizations know a lot about what they’re spending, but they know very little about the costs of the harm that they create. As a result, I think it leads them to underestimate how much they should be investing in this area. 

The average adverse drug event costs around $5,000. The average preventable event costs around $7,500. The average cost of a hospital acquired infection is in the $35,000 to $50,000 range. These are expensive issues. 

An array of new technologies can enable us to improve safety and reduce the costs of care considerably. Investing in those innovations will both improve the care and help with the bottom line.

So far we’ve primarily focused on hospital inpatient care. What about the state of patient safety within ambulatory care? What key safety challenges are prevalent in that environment? 

DB: Patient safety has received relatively little attention compared to inpatient care, but it needs to be addressed. We did a major evaluation of this in the SafeCare study which is currently under review. It is clear that medication-related harm is especially important in this setting, but so is, for example, the safety of outpatient surgery, which is increasingly frequent.

What are the biggest safety improvement opportunities in ambulatory care?

DB: This is still being worked out, but several appear to be improving the safety of outpatient medication use, ensuring that screening tests for cancer are appropriately followed up, and doing a better job monitoring patients with chronic conditions between visits.

Are there any innovative resources, practices, solutions, or technologies that you think could improve patient safety in ambulatory care settings? If so, what are they?

DB: Patient portals are increasingly important—we should be having contact with patients between visits. And home monitoring is increasingly available, especially for patients with conditions like CHF and COPD.  

Beyond clinical surveillance, what safety innovations are most exciting to you right now? 

DB: There are many exciting things, and many of them involve artificial intelligence. Artificial intelligence can help identify things before they’ve actually happened, so that hospitals can intervene and prevent harm. 

One example is adverse drug events. AI could be leveraged to predict which patients are going to respond badly to specific medications. The same is true for pressure ulcers. AI can be used to identify changes in what’s happening with patients that are highly correlated with developing pressure ulcers. 

Five years from now, I think hospitals will be extracting clinical data from their real-time systems and then leveraging AI to go through that and predict who’s likely to have specific types of harm. 

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Read more of this interview with Dr. Bates, as well as insights from other industry leaders, in the latest report on the current state of patient safety from Sage Growth Partners.