Overcoming Challenges of Merging Multiple Patient Identification and Matching Systems: A Case Study.

Northeast Alabama Regional Medical Center (RMC) in Anniston, Alabama purchased a smaller hospital in 2017. Staff at the two hospitals were tasked with merging the two Electronic Medical Record (EMR) systems into one unified system. From the outset, there were two systems with different medical record number specifications and patient identification systems as well as two different patient name parameters. The merging of these records and systems meant dealing with different vendor EMR systems and ancillary systems to produce a single unified record within RMC's EMR and the document imaging system that housed the legal medical record for each patient. This case study describes the process and procedures of merging the patient records from both hospitals to create one Enterprise Master Patient Index (EMPI); and the collaboration between the Health Information Management and Information Technology departments to accomplish this goal. It also reviews the impact and challenges related to the system's development, as well as lessons learned while completing the project.

Information Management in the Emergency Department.

Information management in the emergency department (ED) is a challenge for all providers. The volume of information required to care for each patient and to keep the ED functioning is immense. It must be managed through varying means of communication and in connection with ED information systems. Management of information in the ED is imperfect; different modes and methods of identification, interpretation, action, and communication can be beneficial or harmful to providers, patients, and departmental flow. This article reviews the state of information management in the ED and proposes recommendations to improve the management of information in the future.

Is One-Pen, One-Patient Achievable in the Hospital? A Quality Improvement Project to Reduce Risks of Inadvertent Insulin Pen Sharing at a Large Academic Medical Center.

BACKGROUND: The Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), and Institute for Safe Medicine Practices (ISMP) have issued warnings regarding the risk of potential transmission of blood-borne diseases if an insulin pen is used for more than one person. Many hospitals continue to use insulin pens due to their benefits of decreased risk of dosing error and improved work efficiency. Best practices for insulin pen use have been published; however, little is known about how these perform in hospitals. METHODS: This article describes a multifaceted quality improvement project to address the safety issues of single-patient insulin pens. Major interventions included adding patient-specific bar coding on insulin pens, redesign of labels, systematic removal of discharged patients' medications, and ongoing staff education. RESULTS: Self-reported events of insulin pen sharing events over 40 months showed a significant increase in the number of patient-days between events. The significant change occurred after implementation of patient-specific bar code scanning. There was a gradual decrease in latent errors found during medication drawer audits, and nursing compliance with patient-specific bar code scanning improved over time, reaching 90% on the last recorded month. Of 35 expert recommendations for insulin pen safety, 28 directly affected pen sharing-8 had been implemented prior to this project, and 20 had been implemented by the conclusion. CONCLUSION: Insulin pen use is highly complex in hospital settings where multiple steps provide opportunities for error. To protect patients, all gaps need to be reviewed, and interventions that address major contributing factors are required to ensure safe insulin pen use.

Rapid Patient Discharge Contribution to Bed Surge Capacity During a Mass Casualty Incident: Findings From an Exercise With New York City Hospitals.

BACKGROUND: Mass casualty incidents may increase patient volume suddenly and dramatically, requiring hospitals to expeditiously manage bed inventories to release acute care beds for disaster victims. Electronic patient tracking systems combined with unit walk-throughs can identify patients for rapid discharge. The New York City (NYC) Department of Health and Mental Hygiene's 2013 Rapid Patient Discharge Assessment (RPDA) aimed to determine the maximum number of beds NYC hospitals could make available through rapid patient discharge and to characterize discharge barriers. METHODS: Unit representatives identified discharge candidates within normal operations in round 1 and additional discharge candidates during a disaster scenario in round 2. Descriptive statistics were performed. RESULTS: Fifty-five NYC hospitals participated in the RPDA exercise; 45 provided discharge candidate counts in both rounds. Representatives identified 4225 patients through the RPDA: among these, 1138 (26.9%) were already confirmed for discharge; 1854 (43.9%) were round 1 discharge candidates; and 1233 (29.2%) were round 2 discharge candidates. These 4225 patients represented 21.4% of total bed capacity. Frequently reported barriers included missing prescriptions for aftercare or discharge orders. CONCLUSION: The NYC hospitals could implement rapid patient discharge to clear one-fifth of occupied inpatient beds for disaster victims, given they address barriers affecting patients' safe and efficient discharge.

Benchmarking en la identificación de pacientes: una oportunidad para aprender / Benchmarking in patient identification: an opportunity to learn

Objetivo. Realizar benchmarking sobre la identificación segura de los pacientes en los hospitales integrantes del Club de las 3 «C» (calidez, calidad y cuidados) y elaboración de una ficha común del proceso. Material y métodos. Se trata de un estudio descriptivo de las actividades llevadas a cabo en el proceso de identificación de pacientes en 5 hospitales de media estancia en las unidades de cuidados paliativos y de ictus. Se han seguido las siguientes etapas: recogida de datos en cada hospital, organización y análisis de los datos y elaboración de una ficha común de proceso. Resultados. Los datos obtenidos para el proceso de ictus, del total de pacientes identificados de forma segura fueron: hospital n.° 1 (93%), hospital n.° 2 (93,1%), hospital n.° 3 (100%) y hospital n.° 5 (93,4%). Para el proceso de cuidados paliativos: hospital n.° 1 (93%), hospital n.° 2 (92,3%), hospital n.° 3 (92%), hospital n.° 4 (98,3%) y hospital n.° 5 (85,2%). Conclusiones. El objetivo del trabajo se ha cumplido satisfactoriamente. Se han desarrollado las actividades de benchmarking y compartido conocimientos sobre el proceso de identificación de pacientes. Todos los hospitales han tenido buenos resultados. El hospital n.° 3 destaca en la identificación del proceso de ictus. La identificación de un benchmark es difícil, pero entre los 5hospitales se ha identificado una ficha común útil que recoge las mejores prácticas. Es importante incorporar a la sistemática de las organizaciones la práctica del benchmarking (AU)

Objective. To perform a benchmarking on the safe identification of hospital patients involved in 'Club de las tres C' (Calidez, Calidad y Cuidados) in order to prepare a common procedure for this process. Material and methods. A descriptive study was conducted on the patient identification process in palliative care and stroke units in 5medium-stay hospitals. The following steps were carried out: Data collection from each hospital; organisation and data analysis, and preparation of a common procedure for this process. Results. The data obtained for the safe identification of all stroke patients were: hospital 1 (93%), hospital 2 (93.1%), hospital 3 (100%), and hospital 5 (93.4%), and for the palliative care process: hospital 1 (93%), hospital 2 (92.3%), hospital 3 (92%), hospital 4 (98.3%), and hospital 5 (85.2%). Conclusions. The aim of the study has been accomplished successfully. Benchmarking activities have been developed and knowledge on the patient identification process has been shared. All hospitals had good results. The hospital 3 was best in the ictus identification process. The benchmarking identification is difficult, but, a useful common procedure that collects the best practices has been identified among the 5 hospitals (AU)

Managing the patient identification crisis in healthcare and laboratory medicine.

Identification errors have emerged as critical issues in health care, as testified by the ample scientific literature on this argument. Despite available evidence suggesting that the frequency of misidentification in vitro laboratory diagnostic testing may be relatively low compared to that of other laboratory errors (i.e., usually comprised between 0.01 and 0.1% of all specimens received), the potential adverse consequences remain particularly worrying, wherein 10-20% of these errors not only would translate into serious harm for the patient, but may also erode considerable human and economic resources, so that the entire healthcare system should be re-engineered to act proactively and limiting the burden of this important problem. The most important paradigms for reducing the chance of misidentification in healthcare entail the widespread use of more than two unique patient identifiers, the accurate education and training of healthcare personnel, the delivery of more resources for patient safety (i.e., implementation of safer technological tools), and the use of customized solutions according to local organization and resources. Moreover, after weighing advantages and drawbacks, labeling blood collection tubes before and not after venipuncture may be considered a safer practice for safeguarding patient safety and optimizing phlebotomist's activity.

Identificación de pacientes con lupus eritematoso sistémico: problemas y soluciones / Identifying patients with systemic lupus erythematosus: problems and solutions

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[Development, Application and Evaluation of a Concept for Safe Patient Identification in Hospital - How can Knowledge Transfer Succeed?] / Entwicklung, Anwendung und Evaluation eines Konzeptes zur sicheren Patientenidentifikation im Krankenhaus ­ Wie kann der Wissenstransfer gelingen?

Aim of the Study: In order to minimise the risk of patient misidentification in clinical settings, the German Coalition for Patient Safety published recommendations for safety patient identification in 2008. The aim of this study was to develop, implement and evaluate a theoretical framework of knowledge transfer. The purpose of the framework was to enhance hospital staff's ability to apply the recommendations for safe patient identification in the daily routine of patient care. Method: A data bank-based research and literature review have been conducted. Research topics were: knowledge transfer, change management and implementation science. Within the application of the concept group interviews were held with hospital staff and the interview material was evaluated using content analysis. On this basis a tailored multifaceted implementation strategy has been developed and applied in 8 hospital wards of 4 hospitals belonging to a communal hospital concern. The evaluation of the developed knowledge transfer concept was conducted 4 weeks after the concept application with a written questionnaire. Results: The developed framework concept of knowledge translation consisted of 4 phases built on top of each other: initiation phase; analysis phase; implementation phase; evaluation phase. The multifaceted implementation strategy included 3 interventions: a poster, a computer-based training and a guideline for team meetings. The survey yielded responses from 56 individuals: 96% declared that they know about the existence of the recommendations for safe patient identification; 86% said that they know about the content of the recommendations; 91% have striven to apply the recommendations in the daily routine of patient care; 71% stated that the recommendations for safe patient identification have become integral part in the daily routine of patient care. To become aware of the recommendations and its content the respondents have used on average 2.3 interventions, however the effect of the CBS was relatively small. Conclusion: The developed theoretical framework concept for knowledge transfer provides a way to integrate the recommendations for safe patient identification in the daily routine of patient care and to counteract risk factors promoting misidentification. Therefore a multifaceted implementation strategy is promising.

Tracking the take - Using patient flow data to improve AMU performance and safety.

AIMS: To create a system to co-ordinate the medical take, bed management and track patient flow. To use the system to continuously audit against Society for Acute Medicine Quality Indicators. To use the data to model patient flow and optimise working patterns to improve waiting times. METHOD: An online whiteboard and underlying database system were designed, tested and implemented. Data from this system were used to audit against SAM Quality Indicators and then analysed to optimise both trainee and consultant working patterns. RESULTS: The online whiteboard proved effective and popular as a working tool. Data collection improved using the electronic system. Optimising junior doctor working patterns to match demand led to a reduction of average waiting time to see a doctor from 190 minutes to 71 minutes (p < 0.0001), and a reduction in the proportion of patients waiting over 4 hours from 40% to 10% (p > 0.0001). Optimising consultant working patterns did not produced significant changes in waiting times. CONCLUSIONS: The online whiteboard improved day-to-day working and data collection, when compared to the previous paper-based system. Better data facilitated analysis of working patterns leading to a significant improvement in patient waiting times.

Implementing Routine Head Circumference Measurements in Addis Ababa, Ethiopia: Means and Challenges.

OBJECTIVE: A substantial number of infants in Ethiopia suffer from hydrocephalus. Neurosurgical expertise has until recently been virtually nonexistent in the country; however, since 2006, a neurosurgery training program has been established in Addis Ababa, where hydrocephalus surgery now is performed in 3 hospitals. Our experience is that hydrocephalus is diagnosed and treatment is too late to avoid severe brain damage. Introducing routine head circumference (HC) measurements can ease the detection of hydrocephalus and thus lead to earlier diagnosis, thereby reducing the brain damage caused by the condition. The present pilot project had two major aims: to get the process of implementation started and to gain experience with how this implementation best can be achieved. METHODS: We educated and encouraged the nurse staff members of 12 randomly selected health (mother and child) clinics in Addis Ababa in performing HC measurements, using a recently developed Ethiopian HC chart. Much of the work was related to follow-up. A local Ethiopian healthcare worker was employed to lead the follow-up and to continue the implementation in the remaining 14 clinics. RESULTS: During our attempted implementation of routine HC measuring, we encountered a line of administrational, cultural, infrastructural, and didactic problems and challenges, which are discussed. CONCLUSIONS: The experience we have gained during this pilot project will be used in further development and implementation of routine HC measuring throughout Ethiopia. These experiences may be of interest and use to others wanting to introduce similar routines in low-income countries.

Identification of Aboriginal children using linked administrative data: Consequences for measuring inequalities.

AIM: The aim of this study was to examine the identification of Aboriginal children in multiple administrative datasets and how this may affect estimates of health and development. METHODS: Data collections containing a question about Aboriginal ethnicity: birth registrations, perinatal statistics, Australian Early Development Census and school enrolments were linked to datasets recording developmental outcomes: national literacy and numeracy tests (National Assessment Program - Literacy and Numeracy), Australian Early Development Census and perinatal statistics (birthweight) for South Australian children born 1999-2005 (n = 13 414-44 989). Six algorithms to derive Aboriginal ethnicity were specified. The proportions of children thus quantified were compared for developmental outcomes, including those scoring above the national minimum standard in year 3 National Assessment Program - Literacy and Numeracy reading. RESULTS: The proportion of Aboriginal children identified varied from 1.9% to 4.7% when the algorithm incremented from once to ever identified as Aboriginal, the latter using linked datasets. The estimates of developmental outcomes were altered: for example, the proportion of Aboriginal children who performed above the national minimum standard in year 3 reading increased by 12 percentage points when the algorithm incremented from once to ever identified as Aboriginal. Similar differences by identification algorithm were seen for all outcomes. CONCLUSIONS: The proportion of South Australian children identified as Aboriginal in administrative datasets, and hence inequalities in developmental outcomes, varied depending on which and how many data sources were used. Linking multiple administrative datasets to determine the Aboriginal ethnicity of the child may be useful to inform policy, interventions, service delivery and how well we are closing developmental gaps.

[Implementation and evaluation of error prevention measures in surgical clinics: Results of a current online survey]. / Einführung und Beurteilung von Maßnahmen zur Fehlerprävention in chirurgischen Kliniken: Ergebnisse einer aktuellen Online-Befragung.

In the autumn of 2014, more than 3,000 surgeons completed an online questionnaire asking for the prevalence and efficiency of instruments to prevent adverse events within surgical departments in Germany. About 90 % of the respondents stated that perioperative checklists, preoperative marking of the surgical site and the documentation of hospital infections had been implemented in their institution; and 75 % of the institutions had introduced critical incident reporting systems (CIRS), morbidity and mortality conferences and identification bracelets for patients. The surgeons were asked to rank the different instruments for the prevention of adverse events. According to the respondents, preoperative marking of the surgical site and the use of checklists were at the top of the efficacy ranking, followed by an introductory course for surgeons starting work in a hospital or when new devices became available. Only 50 % of the responding surgeons perceived CIRS as being efficient. Overall, the answers showed that instruments to increase patient safety were commonly available in surgical departments. On the other hand, there is still room for improvement in daily practice.

Healthcare in Disasters and the Role of RFID.

Disasters either natural or man-made are inevitable, and therefore disaster management has always been an important function of government. Since during a disaster healthcare is often adversely affected, a lot of effort has been made in terms of researching effective responses and ways of improving the quality of delivered care to direct casualties and the rest of the community. In this regard, information technology plays an important role to help healthcare systems achieve this goal. One of these technologies that has become popular recently is Radio-Frequency Identification (RFID). This paper explores the relationship between emergency management and disaster healthcare and examines the role of RFID. It is suggested that RFID will become an integral part of disaster healthcare and a means of improving response performance.

Prefetching of medical imaging data across XDS affinity domains.

Prior studies as well as medical imaging data are crucial for a radiologist to diagnose a patient. In this paper the radiological workflow is analyzed from a patient's perspective in order to gain knowledge on how possible existing prefetching strategies still can be applied in connection with a standardized distributed health information system conforming to architectures defined by IHE and ELGA. As a result an adaption to such architectures is proposed and further evaluated in a testing environment. Although the approach presented works in terms of prefetching relevant prior studies together with medical imaging data, additional research has to be carried out on how to apply intelligent search strategies in order to narrow retrieved results concerning their possible utilization for a specific diagnosis.

Data Value in Patient Tracking Systems at Racing Events.

PURPOSE: With the growing popularity of long-distance running races, an emerging area of interest for race organizers is the ability to electronically track and understand participant status throughout events to optimize runner and spectator experience and to identify and respond to the dynamic needs of both communities. This study examines the potential value of developing real-time patient tracking systems (PTS) at marathons based on the Chicago Medical Patient Tracking System (CMPTS). METHODS: Data collected from the CMPTS and timing mats along the course for two running races in 2012 and 2013 were analyzed for data completeness and data value. Subjects consisted of patients who were tracked electronically in the system. RESULTS: A comparison of medical data collected by PTS and paper forms is provided. Once fully implemented, PTS have the potential to capture more accurate and more detailed information compared with paper forms. A significant amount of records obtained by paper forms lacks any time or diagnosis information. CONCLUSIONS: A set of best practices for tracking applications and data collection at marathons is proposed to improve accuracy based on CMPTS implementations from 2012 to 2013. Developing and conforming to standards for data collection at marathons and other mass-gathering events could improve data sets created from PTS, which can be used to improve operational decisions at such events and can provide the foundation for prediction models for enhancing planning and preparedness.