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.

Patient Identification Techniques - Approaches, Implications, and Findings.

OBJECTIVES: To identify current patient identification techniques and approaches used worldwide in today's healthcare environment. To identify challenges associated with improper patient identification. METHODS: A literature review of relevant peer-reviewed and grey literature published from January 2015 to October 2019 was conducted to inform the paper. The focus was on: 1) patient identification techniques and 2) unintended consequences and ramifications of unresolved patient identification issues. RESULTS: The literature review showed six common patient identification techniques implemented worldwide ranging from unique patient identifiers, algorithmic approaches, referential matching software, biometrics, radio frequency identification device (RFID) systems, and hybrid models. The review revealed three themes associated with unresolved patient identification: 1) treatment, care delivery, and patient safety errors, 2) cost and resource considerations, and 3) data sharing and interoperability challenges. CONCLUSIONS: Errors in patient identification have implications for patient care and safety, payment, as well as data sharing and interoperability. Different patient identification techniques ranging from unique patient identifiers and algorithms to hybrid models have been implemented worldwide. However, no current patient identification techniques have resulted in a 100% match rate. Optimizing algorithmic matching through data standardization and referential matching software should be studied further to identify opportunities to enhance patient identification techniques and approaches. Further efforts to improve patient identity management include adoption of patients' photos at registration, naming conventions, and standardized processes for recording patients' demographic data attributes.

Colocación de pulseras identificativas y de grupo sanguíneo en quirófano de ortopedia / Use of identification and blood type wristbands at the orthopedic surgery operating room

OBJETIVO: determinar si es correcta la identificación a través de las pulseras identificativas y de grupo sanguíneo en los pacientes intervenidos de cirugía ortopédica. MÉTODO: estudio descriptivo transversal. La población de estudio fueron los pacientes intervenidos de cirugía ortopédica de prótesis de rodilla y cadera en el Hospital Universitario de Burgos. Técnica de recogida de los datos: observación directa. Variables de estudio: sexo; edad; tipo de cirugía; lado de la cirugía; colocación de pulseras; portador de vía venosa; canalización de vía en quirófano; calibre; retirada de las pulseras; sustitución de las pulseras; tiempo sin pulseras; vía y pulsera en el mismo brazo y planta de origen. RESULTADOS: se analizaron 153 casos. El 100% de los pacientes contaba con una pulsera identificativa y el 98% tenía pulsera de grupo sanguíneo. Fue necesario retirar por colocación incorrecta el 27% de las pulseras identificativas y el 29% de las de grupo sanguíneo; todas fueron sustituidas. La media del tiempo que el paciente pasó en el quirófano sin pulsera con datos personales fue de 51,62 minutos y sin la pulsera de grupo sanguíneo de 50,36 minutos. CONCLUSIONES: la gran mayoría de los pacientes se encontraban correctamente identificados a través de las dos pulseras, aunque por necesidades de la cirugía en algunos casos debían retirarse quedando los pacientes sin identificar durante aproximadamente una hora. La comunicación e información con las enfermeras resulta fundamental para mejorar la calidad de los cuidados y la seguridad del enfermo

OBJECTIVE: to determine if there is an adequate use of identification and blood type wristbands in patients undergoing ortophedic surgery. METHOD: a cross-sectional descriptive study. The study population consisted of patients who had undergone orthopedic surgery for knee and hip prosthesis at the Hospital Universitario de Burgos. Data collection technique: direct observation. Study variables: gender, age, type of surgery, side of surgery, wristband placement, central venous line, IV line catheterization at the operating room, gauge, wristband removal, wristband replacement, time without wristbands, IV line and wristband in the same arm, and ward of origin. RESULTS: the study analyzed 153 cases; 100% of patients had an identification wristband, and 98% had blood type wristbands. It was necessary to remove 27% of the identification wristbands and 29% of the blood type wristbands due to incorrect placement; all of them were replaced. The mean time that the patient stayed at the operating room without a personal data wristband was 51.62 minutes, and 50.36 minutes without blood type wristband. CONCLUSIONS: the vast majority of patients were adequately identified through the two wristbands; though, for surgical requirements, in some cases these had to be removed, and patients were unidentified during approximately one hour. Communication and information with nurses becomes essential in order to improve the quality of care and patient safety

A novel approach to bedside pretransfusion identity check of blood and its components: the Sandesh Positive-Negative protocol.

BACKGROUND: Blood component mistransfusion is generally due to preventable clerical errors, specifically pretransfusion misidentification of patient/blood unit at bedside. Hence, electronic devices such as barcode scanners are recommended as the standard instrument used to check the patient's identity. However, several healthcare facilities in underdeveloped countries cannot afford this instrument; hence, they usually perform subjective visual assessment to check the patient's identity. This type of assessment is prone to clinical errors, which precipitates significant level of anxiety in the healthcare personnel transfusing the blood unit. Hence, a novel objective method in performing pretransfusion identity check, the 'Sandesh Positive-Negative (SPON) protocol,' was developed. METHODS: A nonrandomized study on bedside pretransfusion identity check was conducted, and 75 health care personnel performed transfusion. The intervention was performed by matching a custom-made negative label with blood component with the positive label of the same patient available at bedside who was about to receive transfusion. RESULTS: In total, 85.3% of the subjects were anxious while performing pretransfusion identity check based on the existing standard practice. After the implementation of the SPON protocol, only 38.7% experienced either mild, moderate or severe anxiety. The overall level of satisfaction also increased from 8.0% to 38.7% and none were dissatisfied. Although only 9.3% were dissatisfied about the existing practice, approximately 70.7% felt the need for a better/additional protocol. Clerical error was not observed. CONCLUSIONS: The SPON protocol is a cost-effective objective method that reduces anxiety and increases satisfaction levels when performing final bedside identity check of blood components.

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.

Working towards a master patient index and unique identifiers to improve health systems: the example of Myanmar.

In the health systems of many countries, there is neither a requirement to collect a minimum set of demographic information during patient registration nor a standard way of identifying patients. This impedes the provision of integrated, good-quality care for individual patients and, at the system level, prevents generation of the high-quality data necessary for effective management and continuous improvement. Assigning each patient a unique identifier (UID) to create a master patient index (MPI) is therefore essential to ensure data interoperability across all the points of patient care within a health system. Although advances in technology are shifting the boundary between civil registration and personal identification, the additional value of an MPI/UID system lies in the technical and operational capacity to ensure that clinical data are safely and securely managed. Moreover, operationalization of MPI/UID data enables the establishment of an evidence-based, constantly improving "learning health system" with feedback loops that allow measurement, evaluation and visualization of performance over time. The Ministry of Health and Sports of Myanmar is actively engaged in a multistakeholder collaborative process working towards a nationwide MPI/UID system. Demonstration pilots are planned for both online and offline modes of operation for HIV/AIDS, mother and child health (including eliminating mother-to-child transmission of HIV and syphilis) and hospital settings, which are expected to open up the potential for expansion to all health interventions and facilities. With the implementation of the MPI/UID system under way in Myanmar, the Ministry of Health and Sports is laying the foundation to put individuals at the centre of care and deliver a lifelong service for all.

CALL ME BY YOUR NAME. Paciente protegido: reflexiones sobre lo que implica privar del nombre propio para la Seguridad del Paciente / CALL ME BY YOUR NAME. Protected patient: reflections on removing the patient's name in Patient Safety

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The Relationship between Health Information Technology Laboratory Tracking Systems and Hospital Financial Performance and Quality.

The objective of this study is to explore the relationship between hospitals Health Information Technology (HIT), and financial and quality performance. The study merged the 2017 Centers for Medicare & Medicaid Services (CMS) Healthcare Cost Report Information System, American Hospital Association Annual Survey, and two CMS Hospital Compare datasets. A total of 3002 hospitals were analyzed using multivariate analysis. We found that hospitals with laboratory tracking systems reported better financial performance on five financial performance measures. Policymakers should consider developing policies that facilitate exploration and adoption of various hospital HIT capabilities that measurably improves hospital quality of care.

Transfusion Safety: The Nature and Outcomes of Errors in Patient Registration.

The transfusion chain is susceptible to error at every step. Accurate patient registration is a key first step that links a patient with their historical medical profile, yet patient registration is marked by its own challenges. Registration errors are deviations from standard operating procedures that occur during the process of patient registration. A frequent consequence of registration errors is the obfuscation of historical information and patient misidentification. Through duplicate registrations, patient information can be spread across multiple records and through hybrid registrations information from multiple patients can be combined into a single record. Patients with the same core identifiers, and the misuse of health insurance information also pose a threat to accurate registration. In the context of transfusion, this can lead to ABO discrepancies, failing to match for previously identified alloantibodies, and redundant serological investigations. Other consequences include missed billing opportunities and the inadvertent sharing of medical information. Reducing the occurrence of registration errors can be achieved through a multifaceted approach combining targeted educational efforts with technological improvements to the registration system. A recent development being the use of biometric identifiers. Despite their frequency, published reports on the occurrence and underlying cause of registration errors are rare. Most reports are found within articles on general medical errors or misidentification events and consequently, the true rate of registration errors among health information systems is not known. Here we summarize literature pertaining to how and why registration errors occur and their implications in the context of blood transfusion.

Evaluation of the risk of misidentification of women in a public maternity hospital / Evaluación del riesgo de error en la identificación de mujeres en una maternidad pública / Avaliação do risco de erro na identificação de mulheres numa maternidade pública

ABSTRACT Objective: To determine the frequency of similar names and hospital records of women in a public teaching maternity hospital and the risk of misidentification resulting from the similarity in spelling and pronunciation of the names and in records. Method: Quantitative, documental and case study of 5,975 admissions that occurred between 2011 and 2014. The data name, admission and discharge date, date of birth, hospital record and bed number were collected from an electronic information system. Analysis encompassed descriptive statistics and design of an algorithm for comparison of text and sound. Results: Examination of the names revealed that 86% of the misidentification cases resulted from identical surnames and 96.5% from a sound similarity in the first names. There were patients with identical first and last names at least one day a week. Conclusion: The risk of misidentification of patients is a reality, which stresses the importance of checking and pronouncing the complete names correctly.

RESUMEN Objetivo: Determinar la frecuencia de nombres y registros hospitalarios similares de mujeres en una maternidad pública de enseñanza, y el riesgo de error identificatorio derivado de la homografía y homofonía del nombre y en el registro. Método: Estudio cuantitativo, documental, casuística de 5.976 admisiones ocurridas entre 2011 y 2014. Los datos: nombre, fecha de admisión, alta, nacimiento, número de registro hospitalario y lecho fueron recolectados del sistema de información electrónico. Se realizó análisis por estadística descriptiva y construcción de algoritmo comparativo de texto y sonido. Resultados: Respecto a idéntica escritura, 86% derivaron del apellido y 96,5% por equivalencia fónica del primero nombre. Respecto al riesgo, hubo, al menos una vez por semana, mujeres con nombre y apellido idénticos. Conclusión: El riesgo de ocurrencia de errores identificatorios de los pacientes es una realidad, ratificándose la importancia de la verificación y pronunciación correcta del nombre completo.

RESUMO Objetivo: Determinar a frequência de nomes e registros hospitalares similares das mulheres em uma maternidade pública de ensino e o risco para erro na identificação decorrente da similaridade na grafia e pronúncia do nome e no registro. Método: Estudo quantitativo, documental, casuística de 5.975 admissões ocorridas entre 2011 e 2014. Os dados: nome, data de admissão, alta, nascimento, número do registro hospitalar e leito foram coletados do sistema de informação eletrônico. A análise ocorreu pela estatística descritiva e construção de um algoritmo de comparação de texto e som. Resultados: Quanto à grafia idêntica, 86% decorreram do sobrenome e 96,5% de similaridade do som no primeiro nome. Relativo ao risco, houve, em ao menos um dia da semana, mulheres com o primeiro nome e sobrenome idênticos. Conclusão: O risco para ocorrência de equívocos na identificação dos pacientes é uma realidade, ratificando a importância da conferência e pronúncia correta do nome completo.

Evaluation of the risk of misidentification of women in a public maternity hospital.

OBJECTIVE: To determine the frequency of similar names and hospital records of women in a public teaching maternity hospital and the risk of misidentification resulting from the similarity in spelling and pronunciation of the names and in records. METHOD: Quantitative, documental and case study of 5,975 admissions that occurred between 2011 and 2014. The data name, admission and discharge date, date of birth, hospital record and bed number were collected from an electronic information system. Analysis encompassed descriptive statistics and design of an algorithm for comparison of text and sound. RESULTS: Examination of the names revealed that 86% of the misidentification cases resulted from identical surnames and 96.5% from a sound similarity in the first names. There were patients with identical first and last names at least one day a week. CONCLUSION: The risk of misidentification of patients is a reality, which stresses the importance of checking and pronouncing the complete names correctly.

[Recommendations for the unequivocal identification of the newborn]. / Recomendaciones para la identificación inequívoca del recién nacido.

Newborn identification is a legal right recognised by international and national laws. Moreover, improving the accuracy of correct patient identification is an important goal of patient safety solutions programs. In this article, the Standards Committee of the Spanish Society of Neonatology establishes recommendations to ensure correct identification of the newborn whilst in hospital. Currently, the most reliable method of identification of the newborn is the combination of identification cord clamp and bracelets (mother bracelet, newborn bracelet and cord clamp with the same number and identical and exclusive barcode system for each newborn) and the collection of maternal and umbilical cord blood samples (for DNA testing only for identification purposes).

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.

[Benchmarking in patient identification: An opportunity to learn]. / Benchmarking en la identificación de pacientes: una oportunidad para aprender.

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.

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

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The Role of Patient Navigators in Building a Medical Home for Multiply Diagnosed HIV-Positive Homeless Populations.

CONTEXT: People living with human immunodeficiency virus (HIV) (PLWH) who are most at risk for falling out of HIV primary care and detectable viral loads include homeless and unstably housed individuals and those codiagnosed with behavioral health disorders. The patient-centered medical home (PCMH) is a model that promotes provision of comprehensive, patient-centered, accessible, coordinated, and quality care for patients. This initiative provided patient navigation to HIV-positive homeless and unstably housed individuals codiagnosed with a mental health or substance use disorder as a means to create an adapted PCMH to meet the specific needs of this population. OBJECTIVE: The purpose of this analysis was to characterize the roles and responsibilities of patient navigators as part of an effort to create a medical home for homeless and unstably housed PLWH with behavioral health comorbidities. DESIGN: Eighty-one in-depth interviews with clinic staff and 2 focus groups with patient navigators were conducted. Content analysis was performed to identify key roles and responsibilities of the patient navigators. RESULTS: Patient navigators played an important role in creating a PCMH by working with clients to schedule and complete appointments, develop comprehensive care plans, forging critical relationships with providers both within and outside of health care systems, providing holistic support to increase patient self-management, and assisting in achieving housing stability. CONCLUSIONS: It may be necessary to adapt the traditional PCMH model to effectively meet the social, behavior health, and medical needs of homeless and unstably housed PLWH with behavioral health comorbidities. A patient navigator who can invest time in supporting and connecting these patients to needed services may be a key component in creating an effective PCMH for this population. These findings highlight the roles and tasks of patient navigators that may contribute to developing a PCMH specific to homeless and unstably housed PLWH with mental health and substance use comorbidities. Implementation of such a model has the potential to improve health outcomes (such as retention in care and viral suppression) for particularly vulnerable PLWH and thereby reduce the burden of HIV infection.

Enhancing HIV Treatment Access and Outcomes Amongst HIV Infected Children and Adolescents in Resource Limited Settings.

Introduction Increasing access to HIV-related care and treatment for children aged 0-18 years in resource-limited settings is an urgent global priority. In 2011-2012 the percentage increase in children accessing antiretroviral therapy was approximately half that of adults (11 vs. 21 %). We propose a model for increasing access to, and retention in, paediatric HIV care and treatment in resource-limited settings. Methods Following a rapid appraisal of recent literature seven main challenges in paediatric HIV-related care and treatment were identified: (1) lack of regular, integrated, ongoing HIV-related diagnosis; (2) weak facility-based systems for tracking and retention in care; (3) interrupted availability of dried blood spot cards (expiration/stock outs); (4) poor quality control of rapid HIV testing; (5) supply-related gaps at health facility-laboratory interface; (6) poor uptake of HIV testing, possibly relating to a fatalistic belief about HIV infection; (7) community-associated reasons e.g. non-disclosure and weak systems for social support, resulting in poor retention in care. Results To increase sustained access to paediatric HIV-related care and treatment, regular updating of Policies, review of inter-sectoral Plans (at facility and community levels) and evaluation of Programme implementation and impact (at national, subnational, facility and community levels) are non-negotiable critical elements. Additionally we recommend the intensified implementation of seven main interventions: (1) update or refresher messaging for health care staff and simple messaging for key staff at early childhood development centres and schools; (2) contact tracing, disclosure and retention monitoring; (3) paying particular attention to infant dried blood spot (DBS) stock control; (4) regular quality assurance of rapid HIV testing procedures; (5) workshops/meetings/dialogues between health facilities and laboratories to resolve transport-related gaps and to facilitate return of results to facilities; (6) community leader and health worker advocacy at creches, schools, religious centres to increase uptake of HIV testing and dispel fatalistic beliefs about HIV; (7) use of mobile communication technology (m-health) and peer/community supporters to maintain contact with patients. Discussion and Conclusion We propose that this package of facility, community and family-orientated interventions are needed to change the trajectory of the paediatric HIV epidemic and its associated patterns of morbidity and mortality, thus achieving the double dividend of improving HIV-free survival.

Reduction in Hospital-Wide Clinical Laboratory Specimen Identification Errors following Process Interventions: A 10-Year Retrospective Observational Study.

BACKGROUND: Accurate patient identification and specimen labeling at the time of collection are crucial steps in the prevention of medical errors, thereby improving patient safety. METHODS: All patient specimen identification errors that occurred in the outpatient department (OPD), emergency department (ED), and inpatient department (IPD) of a 3,800-bed academic medical center in Taiwan were documented and analyzed retrospectively from 2005 to 2014. To reduce such errors, the following series of strategies were implemented: a restrictive specimen acceptance policy for the ED and IPD in 2006; a computer-assisted barcode positive patient identification system for the ED and IPD in 2007 and 2010, and automated sample labeling combined with electronic identification systems introduced to the OPD in 2009. RESULTS: Of the 2000345 specimens collected in 2005, 1023 (0.0511%) were identified as having patient identification errors, compared with 58 errors (0.0015%) among 3761238 specimens collected in 2014, after serial interventions; this represents a 97% relative reduction. The total number (rate) of institutional identification errors contributed from the ED, IPD, and OPD over a 10-year period were 423 (0.1058%), 556 (0.0587%), and 44 (0.0067%) errors before the interventions, and 3 (0.0007%), 52 (0.0045%) and 3 (0.0001%) after interventions, representing relative 99%, 92% and 98% reductions, respectively. CONCLUSIONS: Accurate patient identification is a challenge of patient safety in different health settings. The data collected in our study indicate that a restrictive specimen acceptance policy, computer-generated positive identification systems, and interdisciplinary cooperation can significantly reduce patient identification errors.