Medical errors are a major cause of preventable death in the United States. HealthGrades Inc. reported in July 2004 that as many as 195,000 people a year could be dying in American hospitals because of medical errors. The research found 81 percent of the patients who suffered a medical error died. The company studied three years of Medicare data from all 50 states and Washington D.C.
The Institute of Medicine, a division of the National Academy of Sciences, found in a landmark 1999 study that medical errors rank as the eighth leading cause of death in America, ahead of car accidents and breast cancer. According to the Agency for Healthcare Research and Quality, medication errors are the most common medical errors. Hospitals across the country are looking for cures for this treatable disease.
El Camino Hospital in California, which has been outsourcing since the 1960s, was able to reduce its medical errors 20 percent over the last 18 months using new IT technology that changed its drug order entry system. “When you have a physician interact with a sophisticated IT system, you can reduce the number of mistakes,” posits Kendall Stanley, Director of Services Marketing at Eclipsys, El Camino’s IT outsourcer. “You can’t get there without outsourcing technology.”
Modifying the Drug Order Entry System through Collaboration
At El Camino, the central computer system writes all drug orders. Patient safety in medicine administration centers around the five rights: the right person, the right time, the right drug, the right dose, and the right route. “Now computers help the hospital do all that checking,” explains Stanley.
First, a physician initiates the order by typing it into the system. The order is then routed to the pharmacy, where the system and the staff verify there are no drug interactions with other drugs already ordered for the patient. Then the system releases the drug to the hospital floor, where a nurse administers it to the patient. El Camino worked with its IT outsourcer to modify this drug order entry system. “Having a healthy relationship with our technology supplier made this happen,” says Mark Zielazinski, Chief Information Officer at El Camino Hospital. Collaboration is one of the current attributes of outsourcing success.
Requiring a pharmacist to verify every drug before it becomes available to a nurse was one change to the IT system. Another major alteration: Eclipsys software now controls access to the cabinets that house the drugs, which cuts down on errors as well as theft.
These days, a nurse at El Camino selects a patient name on the computer system and the drug cabinet only opens the drawer with that patient’s drugs at the appropriate time. If a nurse accidentally tries to open the drug drawer at the wrong moment, the system will not open the drawer and will inform the nurse of the correct time for the medication.
Some drugs, like pain killers, may be given four times a day or as needed. If a patient wants a fifth dose, only the charge nurse, a physician, or a nurse manager can override the system to gain access to that fifth dose. The system carefully tracks who overrode the system and why.
In the last 18 months since the new system was operational, the hospital has logged five drug errors per 1000 patients. That’s a 20 percent decrease from 2003 errors.
Zielazinski says El Camino was able to cut its medication errors “faster and more effectively” by working closely with its IT supplier. Eclipsys, he points out, was able to implement the new technology and requisite systems sooner than the hospital could do it in-house.
“Most hospitals cannot provide IT operational excellence since it’s not their core competency. But our job is to make sure the hospital’s IT operations run like a fine-tuned machine. We can add the complicated technology the hospital needs to solve real strategic issues,” explains Stanley.
This is a good example of how outsourcing — which combines technology with expertise and domain knowledge — can help a hospital achieve major business goals, in this case, slicing its medical error rate. “Outsourcing ensures patient safety,” says Stanley.
Given the statistics, prospective patients might soon check out a hospital’s IT credentials as well as their surgeon’s diplomas if they want to survive a hospital stay in America.