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Found 146 results
  1. Content Article
    David Stockwell is Chief Medical Officer at Johns Hopkins Children’s Center and Associate Professor of Pediatrics and Anesthesiology and Critical Care Medicine at Johns Hopkins University School of Medicine. He is also Chief Clinical Officer at Pascal Metrics, a federally listed Patient Safety Organisation working with the Betsy Lehman Center on a pilot to test the impact of automated safety event monitoring in a diverse set of six-to-eight acute care hospitals in Massachusetts. Stockwell talked with Patient Safety Beat about Pascal’s approach to using electronic data to transform safety.
  2. Content Article
    Emergency general surgery performed among patients aged over 65 years represents a particularly high-risk population. Transferring emergency surgery patients between hospitals has been linked to higher mortality, but its impact on outcomes in the geriatric population is uncertain. This study in Surgery aimed to explore the effect of transfer between hospitals on postoperative outcomes in older people who have emergency general surgery. The authors concluded that transferring patients between hospitals contributed to overall mortality and morbidity amongst geriatric emergency general surgery patients. They call for further investigation into improved coordination between hospitals, tailored care plans and comprehensive risk assessments, to help improve outcomes for older emergency surgery patients.
  3. Content Article
    An electronic patient record (EPR) often lays the foundation for digital transformation in the NHS. It is essential infrastructure that is as important to a trust as the kits and wires, bricks and mortar, that enables safe, quality and effective care delivery. But just like a hospital rebuild, introducing a new EPR is complicated, expensive and involves many uncertainties. So, it will always require the full attention of the trust board. Mandy Griffin, Managing Director Digital Health, shares seven key learnings.
  4. News Article
    Nurses in the United States continue to voice concerns about artificial intelligence and its integration into electronic health records (EHR), saying the technology is ineffective and interferes with patient care. Nurses from health systems around the country spoke to National Nurses United, their largest labor union, about issues with such programmes as automated nurse handoffs, patient classification systems and sepsis alerts. Multiple nurses cited problems with EHR-based programs from Epic and Oracle Health that use algorithms to determine patient acuity and nurse staffing levels. "I don't ever trust Epic to be correct," Craig Cedotal, RN, a paediatric oncology nurse at Kaiser Permanente Oakland (Calif.) Medical Center, told the nurses' union. "It's never a reflection of what we need, but more a snapshot of what we've done." He said the technology does not account for the hours of preparing and double-checking the accuracy of chemotherapy treatments before a pediatric patient even arrives at the hospital. Read full story Source: Becker's Health IT, 14 June 2024
  5. Content Article
    In this blog, Tina* discusses the patient safety issues that can occur with electronic patient records, highlighting how easily errors can occur in a patient's record but how difficult they are to fix, and why patients must be involved in the digitalising of their own records. Tina gives her perspective as a clinician but also her personal perspective as a patient who has had stigmatising material propagated throughout the system while important clinical information was excluded from her record. 
  6. Content Article
    Healthcare has become increasingly dependent on, and supported by, technology and digital solutions. We've pulled together some key pieces of hub content to help readers take a closer look at some of the patient safety considerations.
  7. Content Article
    An investigation published by BBC News has revealed that Electronic patient record (EPR) system failures have been linked to the death of three patients and more than 100 instances of serious harm at NHS hospitals trusts in England. In this short blog, Patient Safety Learning reflects of these issues and the importance of patient safety being at the heart of the development and implementation of EPRs.
  8. Content Article
    The relentless increase in administrative responsibilities, amplified by electronic health record (EHR) systems, has diverted clinician attention from direct patient care, fuelling burnout. In response, large language models (LLMs) are being adopted to streamline clinical and administrative tasks. Notably, Epic is currently leveraging OpenAI's ChatGPT models, including GPT-4, for electronic messaging via online portals. The volume of patient portal messaging has escalated in the past 5–10 years, and general-purpose LLMs are being deployed to manage this burden. Their use in drafting responses to patient messages is one of the earliest applications of LLMs in EHRs. Previous works have evaluated the quality of LLMs responses to biomedical and clinical knowledge questions; however, the ability of LLMs to improve efficiency and reduce cognitive burden has not been established, and the effect of LLMs on clinical decision making is unknown. To begin to bridge this knowledge gap, the authors of this study, published in the Lancet, carried out a proof-of-concept end-user study assessing the effect and safety of LLM-assisted patient messaging.
  9. Content Article
    This study sought to understand the types of clinical processes, such as image and medication ordering, that are disrupted during electronic health record (EHR) downtime periods by analysing the narratives of patient safety event report data. Patient safety report data offer a lens into EHR downtime–related safety hazards. Important areas of risk during EHR downtime periods were patient identification and communication of clinical information; these should be a focus of downtime procedure planning to reduce safety hazards. The study concluded that EHR downtime events pose patient safety hazards, and the authors highlight critical areas for downtime procedure improvement.
  10. Content Article
    Electronic health record (EHR) nursing summaries have the potential to support nurses in locating and synthesising patient information. However, nurses’ role-specific perspectives are often excluded in the design of the EHR system. The purpose of this study was to describe nurses’ current use of nursing summaries and vital sign information within them and glean their ideas for design improvements. en clinical inpatient nurses participated in interviews and co-design activities. Nurses hardly use the nursing summary to overview a comprehensive patient's health status. The current design of a nursing summary lacks comprehensive patient information and contains much irrelevant data. Nurses prefer vital signs to be prominently displayed on the summary screen for easy visibility. Involving nurses in the design process can lead to a nursing summary that better meets their needs.
  11. Content Article
    This guide is for trusts who have an electronic patient record system (EPR) already in place and want to realise the transformational opportunities it presents. It focuses on the role of the board in leading these changes. In December 2022, NHS England estimated that over 85% of trusts in England had some form of EPR and set a target for EPRs to be implemented in at least 90% of trusts by December 2023. A well implemented and optimised EPR improves patient safety, staff satisfaction, patient flow and data quality. But this can only be achieved with continuous optimisation and investment. A poor EPR implementation, followed by a lack of investment in its ongoing development, can frustrate staff and create disillusionment. This in turn leads to poor usage and unsafe workarounds. In time this will negatively impact productivity and result in substandard data informing clinical decision making. If you are part of an integrated care system (ICS) looking to share or align EPRs across a number of organisations, this guide will also help you consider issues of convergence, scale and shared governance. It does not address procurement and implementation.
  12. Content Article
    Sofia Mettler, MD, describes the day when the electronic medical records (EMR) system at her hospital failed and the impact this had on clinical decision making. She highlights that the downtime forced doctors across the hospital to speak with patients about their condition and symptoms, and to collaborate with the nurses who had been monitoring them all night. It also made her realise that the many test results she was used to referencing for every patient were not all necessary to make clinical decisions. She reflects, "The EMR downtime made me realise that while the system seems to make our clinical routine convenient, it may not result in increased efficiency or better patient care."
  13. News Article
    IT system failures have been linked to the deaths of three patients and more than 100 instances of serious harm at NHS hospital trusts in England, BBC News has found. A Freedom of Information request also found 200,000 medical letters had gone unsent due to widespread problems with NHS computer systems. Nearly half of hospital trusts with electronic patient systems reported issues that could affect patients. NHS England says it has invested £900m over the past two years to help introduce new and improved systems. Some hospital trusts have spent hundreds of millions of pounds on new electronic patient record (EPR) systems, but BBC News has discovered many are experiencing major problems with how they work. Quoted in this article, Clive Flashman, Chief Digital Officer of Patient Safety Learning, said, “If you look at the sorts of serious issues that are coming out around the country where patients are being harmed, in some cases dying, as a result of these systems not working properly, I would imagine there are tens of thousands of these that are happening that probably never get discussed”. Read the full story. Source: BBC News, 30 May 2024 Read more about Patient Safety Learning's reflections on these issues and the importance of patient safety being at the heart of the development and implementation of EPRs here.
  14. Content Article
    6B is a technology and engineering consultancy. It has produced a list of all 214 NHS Trusts in England and the Electronic Patient Record (EPR) they have implemented (as of May 2024).
  15. Content Article
    In this article, published on LinkedIn, Charlotte John explains why digital transformation can be met with resistance and why those leading such projects need to understand why staff may not welcome the change.
  16. Content Article
    This Lancet study examines the discrepancy between occurrence of Long Covid as perceived and reported by participants in longitudinal population-based studies and evidence of Long Covid recorded in their EHRs. The authors argue that this discrepancy might reflect substantial unmet clinical need, particularly amongst patients of non-White ethnicity. This is in keeping with reports from individuals with Long Covid of difficulties accessing healthcare, and poor recognition of and response to their illness when they do.
  17. News Article
    A trust is experiencing severe problems with its electronic patient record system two years after it was installed, HSJ research has revealed. A “preliminary review” into the Oracle Cerner electronic patient record – called Surrey Safe Care – at Ashford and St Peter’s Hospitals (ASPH) Foundation Trust in Surrey found the emergency department was still spending “significant time” using the system, an electronic bed board was not updated in real-time, and there were booking and workflow errors in clinics. The review, which was released to HSJ after a Freedom of Information Act request and carried out in recent months, found problems stemming from limited system training, configuration issues and insufficient technology available on wards and in clinics. The EPR went live in May 2022. The trust also had “insufficient analysts” to provide comprehensive management information. Also, performance, utilisation and management information were described as still being “under construction.” In a statement, ASPH said, “Annual reviews will be carried out to monitor the continual progress of this project. A new working group of clinical, operational, and digital staff will agree how we use existing resources to improve staff training, add extra functionality to the EPR, invest in appropriate technology and additional analysts.” Read full story (paywalled) Source: HSJ, 15 May 2024
  18. Content Article
    Implementing a new Electronic Patient Record (EPR) is a complex process and requires meticulous planning, coordination, involving change across every aspect of a healthcare organization. However, it also presents a unique opportunity to transform patient and staff experiences and enhance productivity by eliminating time-consuming manual processes. This webinar was hosted by Deloitte and brought together some of the UK digital health industry’s most experienced leaders with significant experience in implementing electronic patient records in their own organisations. Panellists included: Dr Cormac Breen, Chief Clinical Information Officer, Guy's and St Thomas' NHS Foundation Trust Jacqui Cooper, RN Chief Nursing Information Officer, Health Innovation Manchester Professor Adrian Harris, Chief Medical Officer, Royal Devon University Healthcare NHS Foundation Trust Dr Henry Morriss, Chief Clinical Information Officer, Manchester Royal Infirmary Consultant Emergency, and Intensive Care Medicine Frances Cousins, Digital Health Lead Partner, Deloitte UK Dr Afzal Chaudhry, Executive Chief Clinical Information Officer, Epic The speakers shared insights for success across a wide variety of topics including crafting a clinical safety case, safely transferring patient data, optimising staff training, preparing for operational readiness across and within organisations and change management for a successful Go-Live.
  19. Event
    Deloitte is excited to announce a follow-up Q/A session to its successful "Safer Electronic Patient Record Implementation" webinar which took place on 18 April. Join this session to hear expert panellists, with first-hand experience in large-scale EPR implementations, answer some insightful questions. Don't miss this opportunity to deepen your understanding for a successful EPR Go-Live. Speakers: Dr Cormac Breen, Chief Clinical Information Officer, Guy's and St Thomas' NHS Foundation Trust Jacqui Cooper, RN Chief Nursing Information Officer, Health Innovation Manchester Professor Henry Morriss, Chief Clinical Information Officer, Manchester Royal Infirmary, Consultant Emergency and Intensive Care Medicine Dr Afzal Chaudhry, Executive Chief Clinical Information Officer, Epic Frances Cousins, Digital Health Lead, Deloitte UK Register for the webinar
  20. Content Article
    David Stockwell, M.D., M.B.A., is Chief Medical Officer at Johns Hopkins Children’s Center and Associate Professor of Pediatrics and Anesthesiology and Critical Care Medicine at Johns Hopkins University School of Medicine. He is also Chief Clinical Officer at Pascal Metrics, a federally listed Patient Safety Organization working with the Betsy Lehman Center on a pilot to test the impact of automated safety event monitoring in a diverse set of six-to-eight acute care hospitals in Massachusetts. In this Q&A session, Stockwell talked with Patient Safety Beat about Pascal’s approach to using electronic data to transform safety.
  21. News Article
    A coroner has issued a warning over a hospital’s new computer system after the death of a 31-year-old woman. Emily Harkleroad collapsed on 18 December 2022 and was taken to the University Hospital of North Durham, where she died the next morning from a pulmonary embolism – a clot on the lung. The assistant coroner for County Durham and Darlington concluded, on balance, that Ms Harkleroad’s death could have been prevented, external. She also noted computer system concerns had been raised by a number of clinicians. Read full story Source: BBC News, 24 February 2024
  22. Community Post
    Hi, we at patient Safety Learning are looking to hold a virtual round table in the last week of June to look at how to improve patient safety related to the implementation of EPRs. If you are a clinician who has been directly involved with the roll out of an EPR, then you could be part of the event. All notes taken at the event will follow Chatham House rules and your participation will not be disclosed outside the round table group if that is your preference. If you'd like to be involved, please contact me (Clive Flashman) directly at support@pslhub.org Many thanks, Clive
  23. Content Article
    This article tells the story of 61 year-old Susannah Constantine who was diagnosed with a rare neurological condition after her MRI was not looked at by her GP surgery for over a year. Susannah decided to have a private MRI when doctors couldn't diagnose why she’d been suffering from tinnitus and pins and needles in the fingers of her left hand. The results were sent to her GP, and Susannah heard no more, so struggled on for another year—she gradually became weaker and her muscles atrophied. She called her GP surgery to check if the MRI held any clues and learnt no one there had ever looked at the results—they had just been sat there for a year. She was told she needed to see a neurosurgeon immediately and was diagnosed with arteriovenous malformation (AVM), a rare neurological condition that disrupts the flow of blood and oxygen to the brain. If not spotted and treated in good time there is a one in three chance of suffering a brain haemorrhage, paralysis or stroke.
  24. News Article
    A failure to share medical information between IT systems contributed to the death of a man in prison custody, a coroner has concluded. In a newly published report on the death of Finlay Finlayson at HMP Lewes in 2019, the coroner highlighted “information sharing” problems and “permissions issues” between the prison IT system and that of the man’s GP surgery. Mr Finlayson died from blood clots in his lungs, having suffered from multiple long-term health conditions including cancer during his life. At the time of his death in 2019, health services at HMP Lewes were provided by Sussex Partnership Foundation Trust, though they are now provided by the Practice Plus Group. According to the Prevention of Future Deaths report issued last month, coroner Laura Bradford heard evidence that Mr Finlayson’s care was affected by “confusion and uncertainty about his medical conditions caused by information sharing and permissions issues with SystmOne”. It appears the GP practice had not enabled sharing of the data, which would have been required for it to be accessed in the prison. Read full story (paywalled) Source: HSJ, 22 April 2024 Further reading on the hub: NHS England warns electronic patient record could pose ‘serious risks to patient safety’: what can we learn? The digitalising of patient records — why patients MUST be involved
  25. Content Article
    'Vinney' died of pulmonary thromboemboli due to deep vein thrombosis with a background of metastatic carcinoma of the base of the tongue following cardiac arrest on 25 January 2019 at HMP Lewes (Cell 216 on C-Wing), whilst on remand. He was pronounced dead at 9.16 am. The jury considered that Vinney’s care was affected by the following issues, the absence of which may have delayed or changed the circumstances of his death. There was confusion and uncertainty about his medical conditions caused by information sharing and permissions issues with SystmOne, leading to an over reliance on Vinney’s own statements. Some poor record keeping on SystmOne and confusion over when to reference the system. This affected both plans and reporting of interactions. Failures in communication between agencies and shifts, not helped by the numbers of different staff and agencies involved, high demand and challenging workloads and associated delays in accessing healthcare. This was particularly relevant between 21 and 24 January 19. In particular a lack of quantifiable evidence, e.g. NEWS scores or notes of proportionate follow-ups and recorded observations between 21 and 24/1/19 which may have allowed any deterioration in Vinney’s condition to be missed. On 25/1/19, there was a grave and unacceptable failure in communications with two or three emergency radios switched off in contravention of prison rules and protocols. This was then compounded by a delay in timely response, i.e. the proposal of a phone call rather than an in-person response, which may have been longer had it not been for decisive intervention from comms. This was followed by unacceptable indecision on calling an ambulance, in which perceptions of Vinney’s mental health were a factor, and should have been automatic on account of his head injury.
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