While the DH declares progress in the war against hospital infections, a disturbing Healthcare Commission report into deaths at Stafford Hospital shows that infection control is not the only aspect of patient safety in the NHS to require attention. Among the new steps the NHS is taking is the adoption of a surgical safety checklist – and some UK healthcare companies are developing products to support its use. On Target looks at how medtech is advancing the patient safety agenda.
The war against MRSA and other healthcare-associated infections is slowly but surely being won, as regular DH reports inform us. However, there are signs that the focus of concern over patient safety in the NHS is shifting to other areas: gaps or mistakes in patient care caused by a shortage of time, resources, staff and training. These are all areas in which the medical technologies industry can make a difference by providing solutions that are designed to help clinicians bring together safety and efficiency.
In the March issue of On Target, Stephen Ramsden, Chief Executive of Luton and Dunstable Hospital NHS Foundation Trust and a leading member of the National Patient Safety Agency (NPSA), drew attention to such aspects of patient safety as rescue failure (linked to failure to monitor the vital signs of acutely ill patients), pressure sores and surgery errors. All of these involve some level of neglect, with healthcare technologies being used incorrectly or not at all.
The Healthcare Commission’s report on preventable deaths at Stafford Hospital has brought these issues to national attention. About 400 more people died at Stafford Hospital between 2005 and 2008 than would be expected, the report said. It identified deficiencies at “virtually every stage” of emergency care, with the underlying cause that managers prioritised financial and efficiency targets with the goal of achieving foundation trust status, to the detriment of patient care.
The investigation began in April 2008, after local complaints were backed up by statistics showing a high death rate. The report cited low staffing levels, lack of equipment, poor training and ineffective systems for identifying failure. It noted, for example, that there were not enough nurses to provide adequate care; that heart monitors were turned off in the emergency assessment unit because nurses did not know how to use them; and that patients were moved from A&E to a ward without nursing care so that the four-hour A&E waiting time target could be met.
The Commission said that Stafford Hospital’s “strategic focus was on financial and business matters at a time when the quality of care of its patients admitted as emergencies was well below acceptable standards.” It warned trusts nationally to ensure that a preoccupation with finances and strategic objectives did not compromise patient care. It also called for all NHS hospitals to be able to access reliable information on comparative mortality and other outcomes.
Ian Kennedy, the Commission’s Chairman, said: “This is a story of appalling standards of care and chaotic systems for looking after patients. There were inadequacies at almost every stage in the care of emergency patients.” He added: “Targets or an application for foundation trust status do not lessen a board’s responsibility to its patients’ safety.”
With the Government pushing for all NHS hospital trusts to become foundation trusts by the end of 2010, the conflict between financial performance and patient safety is likely to recur. But with the legal costs of patient harm spiralling and organisational survival at stake, there is no margin for error. While targeted intervention, supported by new medical technologies, is reducing the incidence of ‘superbugs’, other problems driven by lack of time, staff and training are in urgent need of solutions.
In January of this year, a pilot study by the World Health Organisation (WHO) stated that millions of lives could be saved on the operating table through the use of a Surgical Safety Checklist. The NPSA has now issued an alert that requires NHS organisations in England and Wales to implement the WHO Surgical Safety Checklist for every surgical patient by February 2010.
The WHO pilot study ran in eight hospitals around the world, and collected data from non-cardiac patients. It concluded that the use of a checklist can cut the death rate from surgery by 47% (from 1.5% to 0.8%) and the complication rate by 36% (from 11% to 7%). Hence, for the estimated 8 million operations performed every year in England and Wales, the checklist could prevent over 50,000 fatalities each year.
The WHO checklist specifies 19 steps of checking and recording to be completed before, during and after surgery. A similar system is used in aircraft cockpits before take-off to ensure that the whole team checks everything before the plane leaves the ground. With its capacity to drive improvements in teamwork and communications, the checklist is an important step forward.
However, as Tony Davis, CEO of Medilink West Midlands, points out, the checklist alone will not solve the problems that trigger surgical errors. “At the moment, it’s just a piece of paper, another piece of administration for our overworked NHS teams. But by using technology to prompt and record the process, keeping patients safe from error can become a transparent, fast and monitored process.
“By using technology as a safety net, the NHS can ensure that the Surgery Safety Checklist works, that patient safety improves, while enhancing the efficiency of NHS staff and communication. Such innovative technology ensures the checklist approach and ethos can be applied across all areas of the hospital, not just within the operating theatre.” –Tony Davis, CEO, MedilinkWM
“With so many lives at risk because of individuals’ mistakes, it’s essential that hospitals across the UK follow the lead of those surgeons and staff who have already introduced checking systems into their operating theatres and wards, with similar reductions in fatalities and complications.”
Tony Davis points to two examples in the West Midlands of companies that have been working with hospitals to develop innovative medical devices to help the NHS implement the checklist more effectively, assisting the work of surgeons and perioperative teams:
- Birmingham’s Heartlands Hospital has piloted an effective and error-proof way of replicating the checklist using technology. The new electronic wristband from Safe Patient Systems uses passive radio frequency identification (RFID) to improve identification processes, patient safety and staff efficiency, saving money and reducing the risk of lawsuits. The company is in discussion with the NPSA to combine this technology with the Surgical Safety Checklist, making it easier for surgeons and staff to adopt and use.
- A new wireless technology, Near Field Communication from Sero Solutions, allows the user to touch their mobile phone against an electronic tag in order to initiate a task or receive data. The company is looking at ways in which this technology could help all members of a team record their feedback or patient interactions. By sending the URL of a mobile Internet session on a PDA device, each user could contribute their own feedback on the checklist to be viewed before each stage of the surgical procedure.
Wider patient safety issues are being addressed by the Institute for Digital Healthcare at Warwick University’s digital laboratory, which brings together technology experts from the Warwick Manufacturing Group, researchers from Warwick Medical School and key NHS staff to translate scientific advances into improved patient care.
Letting in the light
“By using technology as a safety net,” Tony Davis says, “the NHS can ensure that the Surgery Safety Checklist works, that patient safety improves, while enhancing the efficiency of NHS staff and communication. It will also make the effects of the checklist easier to measure.
“Such innovative technology ensures the checklist approach and ethos can be applied across all areas of the hospital, not just within the operating theatre,” he concludes. “A patient’s entire journey through the hospital, including every interaction, can be checked and recorded.”
By supporting good practice and teamwork, providing cost-effective solutions that bridge clinical and administrative priorities, medtech enables health providers to reconcile the goals of patient safety and organisational efficiency. These solutions can help to make sure that disasters such as the failure of emergency care at Stafford Hospital become a thing of the past.
Medilink West Midlands is an independent organisation working to raise the profile of the medical and healthcare sectors in the UK. For more information, visit www.medilinkwm.co.uk To contact Tony Davis, CEO of MedilinkWM, e-mail firstname.lastname@example.org.