Why trust is the secret to achieving zero preventable deaths

At the Patient Safety Summit earlier this year we considered what steps need to be taken and which innovations are leading the way in delivering on this important ambition    

When I consider the patient safety challenges in healthcare, despite many challenges and pressures, I still see the glass half-full. Why, you might wonder? I take hope from the many examples in which silos and inefficient ways of working are being overcome through innovation that truly improves and save lives. And as the digital transformation continues at pace, forging strong levels of trust between patients and doctors, and in these technologies, is a vital ingredient for success.  

Across the different hats I have worn over my career, as a professor of pediatrics, hospital CEO, and now Chief Medical Officer at Philips, there are a number of examples of truly groundbreaking technologies and solutions that will make the journey of patients in the healthcare system safer, and the work of healthcare professionals even more rewarding.

These examples illustrate that patients can trust that the care they need will be delivered safely, securely and flawlessly. This trust is of paramount importance, especially when sensitive and personal data needs to be documented and shared within the healthcare system, rather than within the confinement of a single doctor’s office, or hospital building.

The connection of medical devices to support seamless data flows and processes is one example where everyone must place their trust in solutions and information networks in place. The purpose is to allow real-time communication, interpretation and clinical decision-support at the point of care. However, each individual patient has to trust that the care team and underlying technology can deliver the right information, in the right moment, to the right people, to support a better outcome in the end.

The importance of patient and doctor trust in data and health technology was the focus of the panel I joined at the Patient Safety Summit in Huntington Beach, California in January. As we discussed at the conference, here are five illustrative examples of innovative data management that is helping the Patient Safety Movement get closer to its ultimate ambition of zero preventable deaths.

1. Removing human error from patient monitoring

A significant step towards zero preventable deaths would be taken if the needs of patients and healthcare professionals in the general ward, where 40% of unanticipated deaths occur (1), are met. One solution making a contribution to this is the IntelliVue Guardian Early Warning Score which enables nurses to quickly identify subtle signs of patient deterioration and provide timely intervention. At Ysbyty Gwynedd, General Hospital in Bangor, UK, where this solution is being utilized, the impact it has had on patient is significant; a 35% reduction in serious events, and an 85% reduction in cardiac arrest (2).  

“Philips General Ward Solutions help us to deliver timely care that is matched to patient needs.” 

Dr Chris Subbe, Consultant in Acute, Respiratory and Intensive Care Medicine

Watch this short video to see how staff at Saratoga Hospital, Saratoga Springs, New York State, U.S are applying predictive monitoring to improve safety and the experience of patients and staff.

2. Ensuring that the critical alarms are not missed

Another significant, but somewhat surprising, hurdle impeding the journey to zero preventable deaths is alarm fatigue. Patients, staff and families can be exposed to up to 700 alarms a day (3). The very alarm tools which are meant to aid clinicians are in fact creating a sense of being overwhelmed. The flooding of noise is making this particular technology counterproductive. The result is that alarms are being silenced, monitoring protocols broken and emergency alarms are being missed, all putting patients at greater risk. Added to this, alarm fatigue can also cause stress, depression, reduced productivity and burnout among clinician, making this a challenge that needs addressing (3).

One solution to this is Alarm Advisor, available on the Philips Patient Monitoring System. The Alarm Advisor application is a clinical decision tool that provides feedback on recurring and prevailing alarm limit violations, for specific measurements. This customer-centric innovation is enabling clinicians to overcome the hindrances of alarm fatigue, providing support for adapting alarm limits specific to the patient.

3. Improving the experience for patients in the ICU

Figures on the prevalence of delirium among the millions of patients around the world admitted to the ICU each year vary from 20% to 80% (4), depending on the severity of illness and diagnostic methods used. Delirium represents a significant hurdle in the Patient Safety Movement journey to zero preventable deaths.

Delirium is a complicated problem, which can develop even when patients spend only a short period on the ICU, and usually manifests itself as a fluctuating disturbance of consciousness and cognition, which is disturbing for both the patients and the family.

The price to pay is hefty. Delirium increases the average length of stay in the ICU by between five and ten days, which globally adds billions to already burgeoning healthcare costs. In the U.S. alone delirium adds $145 billion per year to the bill (4).

However, it is the cost to the patient that is most worrisome. Among medical ICU patients, delirium is associated with multiple complications and adverse outcomes, as well as a threefold increase in risk for 6-month mortality (4).

Philips VitalMinds delirium management solutions is taking important steps to tackling this currently unmet need, by providing an integrated, multi-component solution for delirium. Adaptations to light and sound conditions, during both day and night time, attenuate the stress patients experience when transitioning from the usual home environment, via the emergency room or operation theater, to the impulse-rich ICU environment, by artificially recreating familiar place and time conditions. 

4. Minimizing invasion during diagnosis and treatment

Some risks to patient safety can be eliminated, others can only be reduced. For example, the exposure to radiation that patients experience during x-rays and CT scans. With elimination not an option thus far, the overall goal is to provide clinicians with the best possible diagnostic information at the lowest possible dose.

Steps to achieving this are threefold. Firstly, flexibility in the process, which typically follows a pattern of an x-ray first, then CT scan, then an MRI or other variant. Skipping stage one and starting with the more accurate CT scan can help save time, expense and exposure.

Secondly, optimizing the process. An example of this is Philips’ Azurion Image Guided Therapy system, which combines high image quality at ultra-low X-ray and navigation tools for cardiac intervention. Parallel working enables the team of clinicians to complete different tasks simultaneously in the interventional lab, saving valuable time without compromising quality of care. These are the type of results upon which patient and healthcare professional trust is built.

Finally, improving the procedure, namely the treatment. A good example of this is the MR Linac machine. Developed in partnership between Philips, Elekta, and a consortium of university hospitals, the solution combines two technologies – an MR scanner and linear accelerator – to precisely locate tumors, tailor the shape of the irradiation beams in real-time and accurately deliver doses of radiation to moving tumors. This technological innovation, which hopes to deliver more confident diagnosis with minimized side effects, has been described by the Royal Marsden Hospital, London – where it is being tested – as ‘groundbreaking’ (5). 

5. A seamless solution to a complex challenge

Early diagnosis and effective treatment of the oncological disease, which currently accounts for nearly one in six global deaths (6), is difficult enough without adding preventable deaths to the equation.

This is why IntelliSpace Oncology, a cloud-based oncology solution is such an important innovation to improve clinical collaboration and decision-making in cancer care. What it offers stakeholders along the patient journey is seamless data integration across specialties and locations. This includes data-driven decision-making for proactive patient involvement in their treatment section. Available through a single-view dashboard, these capabilities enhance patient-centric care.

A pilot study, ran in collaboration between co-creators Philips and Leiden University Medical Center (LUMC), Netherlands, indicated that approximately half the doctors using the solution stated that it shortened the time spent reviewing each patient case. The program also showed further optimization of guideline adherence by 12 percent.

A few final thoughts

As the industry seeks to enable providers to move the needle on patient safety, in a united effort to deliver on the Patient Safety Movement’s ambition of zero preventable deaths, it is evident that among many essential factors, trust is the key. It is trust which enables the deployment of sensitive and individual patient data for adaptive intelligence in comprehensive, integrated solutions, that facilitate seamless and safe care. Without trust, large amounts of data, analytics, digitization and connectivity will be futile, denying healthcare professionals the possibility of treating their patients with even greater care, at a lower risk of unnecessary and unintentional harm.

If we build trust, and in turn deliver end-to-end solutions, no matter how many stakeholder boundaries must be crossed, then we will take a big stride towards tackling this particular healthcare challenge. The Patient Safety Movement has my full support. I hope too that one day, the safety of patients will be one less thing keeping practitioners, and of course patients themselves, awake at night.

References

1. Rutherford P, Lee B, Greiner A. Transforming Care at the Bedside. IHI Innovation Series white paper. Boston: Institute for Healthcare Improvement; 2004. (Available on www.IHI.org)

2. Subbe CP, Duller B, Bellomo R. Effect of an automated notification system for deteriorating ward patients on clinical outcomes. Crit Care. 2017 Mar 14;21(1):52.Results are specific to the institution where they were obtained and may not reflect the results achievable at other institutions.

3. Cvach, M., "Monitor Alarm Fatigue: An Integrative Review", Biomedical Instrumentation & Technology, July/August 2012, pp. 268-277

4. Girard T D, Pandharipande P P & Ely E W, Delirium in intensive care unit, US National Library of Medicine, National Institute of Health. Link.

5. Tree, A Dr, Royal Marsden Hospital, London, UK, 2019, Link

6. The World Health Organization, February, 2017, Link