17 Mar

Patient deterioration #2 patient safety concern

ECRI Top 10 Patient Safety Concerns for Healthcare Organizations

ECRI Institute Releases Annual

Top Ten Patient Safety Concern List

Based both on analysis of 1.5 million event reports from the patient safety organization database and a review of those representing high priorities because they are new, changing or persistent, the ECRI Institute’s Top 10 Patient Safety Concerns for Healthcare Organizations has become a staple for teams looking to focus their patient safety improvement programs on the most pressing of problems.

Our interest in the following concerns should come as no surprise.  They are,after all, those that we can help hospitals with:

#2: Unrecognized Patient Deterioration

#3: Implementation and Use of Clinical Decision Support

#10: Inadequate Organization Systems or Processes to Improve Safety and Quality

The link between PeriGen’s software and helping labor & delivery clinicians recognize and respond to patient deterioration is a no-brainer.  It’s what our neural-network based clinical analytic tools that offer both pattern recognition and protocol compliance management are designed to do.  Our latest tool, HUB, is an early warning dashboard created specifically to highlight unrecognized patient deterioration, allowing clinicians to rapidly respond to maternity patients at risk.

What’s not so obvious is how PeriGen software helps with #3 and #10.

  • PeriGen’s cues and notifications are designed to make it as easy as possible to know when a patient needs attention.  The color-coding, combined with the option of sound, mean that the warning amplifies and focuses clinical attention on the areas of the strip and protocol parameters that are of the greatest concern at a moment in time.  Trend analysis, additionally, brings a bigger picture view of small, individual points of data showing clinicians what’s significant…and what’s not.
  • Today’s clinicians are awash in not only data and documentation, but in training programs.  These are essential of course to improving safety and quality, but the sheer volume of training information makes “safety net” technology like PeriGen’s software crucial for turning training into actual behavior.
  • Automating processes that have proven to improve patient safety and prevent negative outcomes is an important strategy for standardization of care.  Manual processes, especially when there are so many of them, are prone to breakage and change over time.  Automation, such as that offered by PeriGen’s CheckList tool, also has the added benefit of easing the weight of manual tasks bedside clinicians are faced with.

We encourage you to take a look at the ECRI Institute’s list of Top 10 Patient Safety Concerns for Healthcare Organizations.  The preview and Executive Brief are provided free once you register.

 

14 Nov

Pratt Regional adds PeriCALM for Patient Safety

PeriCALM Goes Live at Pratt Regional

The PeriCALM launch team for Pratt Regional Medical Center includes Joanne Fullerton, Trent Green and Lisa Steele of PeriGen, as well as Stephanie Simmons and Amanda Vandervoort of Pratt Regional

Pratt Regional Medical Center, serving Pratt, KS, went live this week on PeriCALM.  They’ve added the Patterns patient safety tool, as well as the PeriCALM fetal surveillance tool.  The installation includes an ADT interface and Coldfeed.

Pratt Regional Medical Center is a progressive provider serving south central Kansas and the pan-handle of Oklahoma.

29 Jul

Trending in OB

Telehealth in labor & deliveryTelemedicine Branching Out to the Smallest Patients

Telemedicine is getting much attention these days as innovative health systems look to increase operational efficiency and patient satisfaction. Leaders such as Stephen Klasko, MD at Thomas Jefferson University Hospital are mandating telemedicine and this top down approach will surely accelerate adoption.

Telemedicine is quickly moving beyond telestroke and the ICU. At least one major EMR company and one of the nation’s leading health systems – fortunately a PeriGen client – are investing significant resources to bring telemedicine to labor and delivery. Complexity, risk and attrition in the ranks of OBs and MFMs make labor and delivery an ideal service line in which to deploy these technologies. PeriGen’s fetal surveillance platform uses Artificial Intelligence to identify troubling patterns and long-term trends in fetal strips. This real time capability is now at the heart of a telemedicine infrastructure which allows a single OB to be alerted to specific cases – showing patterns identified as the most troubling – across an entire health system.

As a standalone tool or in concert with the above-mentioned EMR module, telemedicine creates a cost-effective way to leverage valuable clinical resources across an enterprise and help safeguard one of a health system’s most risky and most valuable service lines.

I’d love to hear how your meeting the twin challenges of improving patient safety and the expected shortage of labor & delivery providers.

 

05 Apr

Annual Obstetric Malpractice Review

MalpracticeEvery year, according to a study published by The New England Journal of Medicine in 2011, just over 11% of obstetricians and the hospitals and clinicians serving them, will be faced with malpractice complaints. The average payout will be approximately $360,000 with significant state-by-state variation.¹

PeriGen’s Annual Review of
Labor & Delivery Malpractice Awards

Following is a summary of 2015 perinatal malpractice awards, settlements and complaints:

    • $8.4 Million Awarded for Hypoxic Ischemic Brain Injury:   Mother was admitted to the a Georgia medical center for delivery of a full-term baby. The labor continued throughout the evening.  Baby was delivered around noon the next day. Her admitting physician was not present at the delivery, but delivery was overseen by a CNM. For several hours prior to the delivery, fetal heart rate was noted as decelerating and variable. Infant was born severely depressed, with low APGAR scores and metabolic acidosis. He was not intubated for 8 minutes, and he continued to deteriorate, a full code ensued, and resuscitation occurred. Ultimately, infant was diagnosed with a hypoxic ischemic brain injury and developed cerebral palsy. Click for details
    • A Michigan court granted the right to appeal for a case stemming from a 2008 delivery outcome.  Mother  was admitted to the hospital with ruptured membranes. She had a lengthy labor – 29 hours – augmented by the drug Pitocin.  The baby failed to descend after two hours of pushing. The mother had developed chorioamnionitis (placental infection) and the doctors noticed the presence of meconium. The labor was terminated with a caesarian section. Records revealed “delivery of a healthy baby boy who weighed 9 lbs 13 oz. However, the infant began to show signs of seizing shortly after his birth and a CT scan revealed an acute left middle cerebral artery ischemic stroke, which was “days to hours old.” The complaint alleged that “[t]he baby was at risk for, and did develop, brain injury from traumatic head compression and regional cerebral ischemia caused by failure to descend, macrosomia (large baby), excessive contractions in the presence of failure of descent as augmented with oxytocin, hypoxia-ischmeia (regional cerebral and/or systemic) caused by uteroplacental insufficiency and by cord compression and head compression.” The complaint alleged that defendants were negligent in administering oxytocin, in failing to properly respond to fetal heart rate changes, and in failing to perform a timely c-section. Click for details
    • A couple in Puerto Rico filed a suit for $27 million against two hospitals as a result of respiratory failure, perinatal asphyxia, and clinical sepsis. After experiencing pelvic pressure and secretions the mother was admitted without contractions or amniotic rupture. The mother underwent induced labor. Upon birth, the newborn was found  to be in critical condition. His skin was blue from poor circulation, and he did not respond to any external stimuli.  The boy was rushed to NICU and hooked up to a mechanical ventilator. He was diagnosed with respiratory failure, perinatal asphyxia, and clinical sepsis. After nearly a month of care, the boy was released from treatment. Then in January 2013 doctors diagnosed him with multicystic leukoencephalopathy and microcephaly, from which stemmed a host of motor, mental, and sensory complications, such as seizures and impaired vision and hearing. Click to review case
    • A New Jersey family realized a $700,000 malpractice settlement as a result of a Erbs palsy brachial plexus injury.  The case contends that the attending physician used excessive traction during  delivery, resulting in stretching and tearing of the brachial plexus. See details
    • Another settlement, this one for $562,500 followed a complaint that the obstetrician and nurse, monitoring a patient in labor, failed to recognize that the infant’s heart rate had slowed when the fetal monitor strips was actually demonstrating the mother’s heart rate. The mother’s uterus had abrupted, causing a lack of blood flow and oxygen to the baby. By the time the error was recognized, the infant had died from lack of oxygen.  Details provided here
    • Hypoxic ischemic encephalopathy (HIE) with extensive brain injury is the subject of a recent medical malpractice claim brought against a military hospital in the District of Columbia. The complaint states that after being admitted to the medical center in the early stages of labor, the plaintiff was given oxytocin to help augment contractions. Subsequent fetal heart monitoring suggested an abnormally high rate of contractions, but augmentation was continued. Following this, medical records indicated an increase in the fetal heart baseline along with intermittent late decelerations. Shortly thereafter, the mother developed a fever and was diagnosed with chorioamnionitis (a bacterial infection of the fetal membranes). After several hours of prolonged labor, the plaintiff was delivered, at which point shoulder dystocia was noted.  Allegedly, a first year resident then unsuccessfully attempted to relieve the shoulder dystocia with downward pressure. Next, a third-year resident tried several maneuvers to free the baby’s shoulder, including the McRoberts maneuver, the Rubin maneuver and others. All were ineffective. At this point, contends the complaint, the attending obstetrician arrived and was able to successfully free the shoulder allowing for a vaginal delivery. Upon delivery, the plaintiff’s little girl was was described as having bruising on the face and scalp, a fractured right clavicle and Erb’s palsy. She was also hypotonic and experienced seizures. About five days after her birth an MRI revealed that the child showed hypoxic ischemic encephalopathy with extensive brain trauma. See more
    • Honolulu based hospital faced with $9,000,000 obstetric settlement:  The mother arrived at the hospital at 35 weeks into her pregnancy, she had severe lower abdominal pain. Because of her previous history of miscarriage and the complicated delivery of her first child, the mother had undergone a procedure to keep her uterus closed until delivery and the pregnancy was under close supervision. However, when she arrived at the hospital, the hospital failed to notify and consult her obstetrician. An emergency C-section was performed, but the complaint contends that the procedure was not performed in time to prevent reduced oxygen flow to the fetal brain, causing brain damage. Click for more information
    • A $5 million suite filed against a military hospital in Kentucky also results from HIE. The suit contends that connected to a fetal heart rate monitor, the healthcare workers failed to properly monitor and interpret the tracings. The plaintiff claims that the medical records indicate her daughter was in respiratory failure for a long period of time. In addition, the complaint states that, despite knowing that the labor was not progressing properly, healthcare providers failed to perform a cesarean section. The newborn was diagnosed with intracerebral hemorrhage and interventricular hemorrhage. Click for details

 

¹Anupam B. Jena, M.D., Ph.D., Seth Seabury, Ph.D., Darius Lakdawalla, Ph.D., and Amitabh Chandra, Ph.D. Malpractice Risk According to Physician Specialty N Engl J Med 2011; 365:629-636