Radical Improvement in Quality of Patient Care is Possible

Enhanced automation and integration to avoid oversights, mistakes, and medical errors are only the tip of the iceberg in improvement possibilities for health care. Radical improvement in the overall quality of care is possible not only by reducing the incidence of medical errors, but also by deeply reinventing existing health care processes.

Important areas for business process redesign related to the success of current medical practices entails research of new clinical protocols and design of disease management systems. Business process integration offers a promising solution for rapid adoption of new treatments in practice by promoting new techniques through automated alerts and recommendations, while reducing negative side effects by displaying warnings and recent analyses of outcomes.

For example, it currently takes an average of 17 years for evidence-based medicine to be integrated into clinical practice [5], and research shows that physicians incorporate the latest medical evidence into treatment only about 50% of the time.

Our results indicate that, on average, Americans receive about half of recommended medical care processes. Although this point estimate of the size of the quality problem may continue to be debated, the gap between what we know works and what is done is substantial enough to warrant attention. These deficits, which pose serious threats to the health and well-being of the US public, persist despite initiatives by both the federal government and private health care delivery systems to improve care.

S. Marsland and I. Buchan [24]

Opportunities for unobtrusively automating the introduction, suggestion, or recommendation of the latest evidence-based medical practice into clinical processes could generate a revolutionary improvement in patient outcomes. The impact of monitoring and managing small increments of clinical behavior can have enormous consequences. A recent study [31] showed that inpatient medication error is the fourth leading cause of death in the United States (113,000 deaths), with nosocomial infections not far behind (90,000 deaths). Inpatient surgery and postoperative care appear to significantly contribute to adverse events. An analysis of 15,000 nonpsychiatric hospital discharges revealed that 66% of adverse events were found related to surgery [7]. For example, failure to give antibiotics within 2 h before surgery doubles the postoperative deep wound and organ space infection rate, compounding medical error with nosocomial infection (Fig. 8.1). Automated monitoring and alerting on this relatively simple event generates a significant improvement in care [20].

Automated monitoring of order entry and medication administration is easily implemented with new information systems coming on line. Even with older systems, for example, it is currently possible with systems in place at the University of Maryland Medical Center (UMMC) to monitor order status of a medication and to generate an automated query to a care provider prior to patient surgery to confirm proper antibiotic delivery.

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