by Michael Woods, Global Chief Medical Officer, caresyntax

August 27, 2019 – When one speaks of patient injury in healthcare, it’s easy to point at the statistics. However, almost everyone has a friend or family member who is represented by those statistics. Through that lens, patient harm becomes very personal. Yet the rate of all-cause harm — situations that cause or have the potential to cause patient injury — has not declined significantly since the IOM’s Crossing the Quality Chasm report in 2001.^[1]

Healthcare systems with automated all-cause harm detection have found the operating room is the most dangerous place in the hospital, generating the greatest number of injuries.^[2] In fact, surgical adverse events are the “cause-specific” reason for death in 64% of adverse event associated deaths in the U.S, with another 4.5% of deaths being attributed to the use of devices used for medical intervention, including surgical procedures.^[3] And it’s not just a problem in U.S. Globally, surgical adverse events are the third leading cause of death, after coronary heart disease and stroke.^[4]

In a study of over 90,000 surgical patients, patients who had surgical complications were over four-times more likely to be readmitted in a 30-day period compared to those without complications.^[5] A separate study showed surgical patients readmitted within 30 days were over three times more likely to have had a surgical complication than those who did not (53% vs. 16%).^[6] Intraoperative adverse events (iAEs) increase expenses between 27 – 54%, and total charges are nearly $14,000 in the surgical iAE population — fully three times higher than the all-cause harm group noted above.^[7] Beyond the human and health-care related costs, intraoperative errors account for 75% of closed claims related to surgical care. Yet there is a poor understanding around intraoperative events and postoperative outcomes.^[8] Finally, these data are in the background of “new and improved” technologies, e.g. robotic surgery, where it is increasingly recognized that surgeon training may be sub-optimal and robotic-related injury under-reported.

The punchline? We should do better. We can do better. We must do better.

Solutions to these complex problems must be based on sociotechnical sense— an approach that integrates an understanding of people, processes, and tools in a unified effort to create a safe surgical environment resulting in higher-quality care while reducing the clinician’s cognitive burden in care delivery.

What would that look like? It would be a comprehensive, integrated, surgery-specific system that enables:

• Longitudinal, video-based, standardized assessment of surgical procedure technical performance with the goal of continuous improvement;
• Establishment of a video reference library of exemplar surgical procedure performance, enabling side-by-side comparison of cases for learning by surgeons across their career;
• Easy-to-use, integrated event reporting, specific to the surgical environment, requiring minimal data input by the frontline, incorporated seamlessly into their workflow, leveraged for non-punitive learning and clinical improvement, and capturing not just complications, but also device malfunction, drug reactions, and human factors-related error;
• Clinical decision support to prevent all-cause harm by leveraging siloed electronic health record data.

This sounds too difficult? Unprecedented?

Can you imagine an NFL quarterback and their coach not reviewing video of their practice and game performance, with an eye towards continuous improvement? Link the occurrence of a performance-related turnover to an improvement opportunity? If video review and tracking interceptions or missed tackles is standard practice in sports — even amateur sports — why wouldn’t video review of surgical performance and tracking of all-cause harm be standard practice in the high-risk arena of surgery? If your loved one needs surgery, and there are two hospitals in town — one hospital uses such a system and the other does not, where would you take them?

It’s time to take surgery to the next level for the benefit of our biggest fans: our patients.

About the Author

This article was written by by Michael Woods, MD, MMM with support from Sean Witry and Gargee Kashyap

Michael S. Woods MD, MMM, a board certified, fellowship trained surgeon, is a creative, progressive leader with global experience who has helped design, build and implement successful, innovative digital patient safety solutions with a focus on making caregiver lives simpler and care delivery easier in the complex healthcare environment. His experience crosses multiple aspects of healthcare, from practicing clinician to administration as a Chief Medical Officer, to the global healthcare industry, where he was a Global Medical Leader with Johnson & Johnson’s Janssen Research Foundation, Novartis’ Director of Medical Affairs for North America, and the Clinical Vice President at Pascal Metrics, a Patient Safety Organization. He was a key consultant to Health Catalyst, where he helped create the patient safety roadmap and define the data and user requirements and frontline functionality of their recently launched Patient Safety Monitor™ Suite. He joined caresyntax (www.caresyntax.com), a healthcare analytics and software company focused on surgical patient safety in Nov. 2018 as their Global Chief Medical Officer and VP Clinical Strategy & Development.

References

^[1] IOM. 2001. Crossing the Quality Chasm: A New Health System for the 21st Century . Washington, DC: National Academy Press.

^[2] Sammer C, Miller S, Jones C, et. al. Developing and evaluating an automated all-cause harm trigger system. The Joint Commission Journal on Quality and Patient Safety 2017; 43:155–165.

^[3] JAMA Netw Open. 2019;2(1):e187041. doi:10.1001/jamanetworkopen.2018.7041

^[4] Global burden of postoperative deaths. Dmitri Nepogodiev, Janet Martin, Bruce Biccard, Alex Makupe, *Aneel Bhangu, on behalf of the National Institute for Health Research Global Health Research Unit on Global Surgery. www.thelancet.com Vol 393 February 2, 2019

^[5] Association Between Occurrence of a Postoperative Complication and Readmission. Implications for Quality Improvement and Cost Savings. Elise H. Lawson, MD, MSHS, ∗ ‡§ Bruce Lee Hall, MD, PhD, MBA,‡¶ Rachel Louie, MS,† Susan L. Ettner, PhD,† David S. Zingmond, MD, PhD,† Lein Han, PhD,|| Michael Rapp, MD, JD,|| ∗∗ and Clifford Y. Ko, MD, MS, MSHS ∗ ‡§ Annals of Surgery. Volume 258, Number 1, July 2013

^[6] Lawson EH, Hall BL, Louise R, et. al. Association Between Occurrence of a Postoperative Complication and Readmission. Ann Surg 2013;258: 10–18)

^[7] Ramly EP, Larentzakis A, Bohnen J, et. al. The financial impact of intraoperative adverse events in abdominal surgery. Surgery 2015;158:1382-8.

^[8] Intraoperative adverse events. The neglected quality indicator in surgery? Kaafarani MH, Velmalhos GC. Surgery 2015;157:6-7. http://dx.doi.org/10.1016/j.surg.2014.10.001