by Kevin Fickenscher

First posted on The Fickenscher Files on 9/13/2013

Kevin Fickenscher, MD, CEO AMIAInformation for your consideration…

In my various presentations across the country, I frequently begin by quoting Marcel Proust who said, “The issue is not in finding new lands.  The issue is in seeing the territory with new eyes.”  We are at that point.  The disruption in the traditions of healthcare is all around us.  And, even though I’m a technophil, I also recognize that technology – in all of its various manisfestations – is the core reason for much of the disruption.  The Internet and mobility are changing our approach to professional collaboration.  Knowledge diffusion and virtual delivery are further altering the framework of how and where we deliver various services.  The end result is that the healthcare system needs to move toward “knowledge creation”.  So, the question is – how do we accomplish that goal?  There are multiple avenues but one such avenue that needs to be seriously considered is the creation of a national “Healthcare Patient Safety Reporting System.”

But, rather than jumping into the concept, let’s take a look at another industry – aviation.  In April 1976, through an act of Congress, the Aviation Safety Reporting System was implemented.  In essence, the system allows pilots, cabin crews, dispatchers, maintenance personnel – virtually everyone who is in and around an airplane to submit a report on a safety problem.  When the system was originally turned on it generated about 400 reports a month; however, it now generates over 5000 reports per month – with the vast majority of those reports submitted by the air carriers themselves.  Why?  Because it generates knowledge on safe airline practices!  The process for the system allows for anyone to submit a report, which is then screened, alert messages are dispatched (if necessary), matching of similar alerts is made, an analysis of the data completed, de-identification occurs, quality checks are performed, and, process improvements are suggested – for ech and every problem that is submitted!!  Imagine that type of system for healthcare…

I fly every week.  I don’t worry about a plane crash.  In fact, the odds of an accident if you fly one of the top 39 airlines in the world is 1 in 10 million and the odds of a fatality are 1 in 20 million.  By the end of 2014, we will have invested close to $25B toward transforming healthcare by shifting it from a “dead data” system of paper charts to a “live data” system that involves the use of health information technology.  Suddenly, we will have information that is digital.  We will be able to capture it, analyze it, de-identify it, perform quality checks on it.  In other words, we will be able to dramatically improve the care that is delivered.  This is the promise of health information technology.

So, let’s consider just one problem – hospital acquired infections (HAIs).  The Centers for Disease Control and Prevention (CDC) estimates that there are roughly 1.7 million hospital-associated infections which cause or contribute to 99,000 deaths each year at an annual cost of between $4.5 billion to $11 billion.  A more recent review suggests that the cost for five of the most common problems represents an additional cost of $9.8 billion of wasted expenditures. Those most frequent type of infections are urinary tract infections (36%), followed by surgical site infections (20%), and bloodstream infections and pneumonia (both 11%).  On September 2, a new meta-analysis was released on JAMA Net noting that the central line–associated bloodstream infections were the most costly HAIs at $45,814, followed by ventilator-associated pneumonia at $40,144, surgical site infections at $20,785; and, catheter-associated urinary tract infections at $896.

In 2012, there were 35 million admissions to hospitals across the nation resulting in about one infection for every 20 admissions and one death for every 350 admissions.  That means, that the average 350 bed community hospital with roughly 25,000 admissions would experience 70 deaths from hospital acquired infections on average or, about five deaths per month or roughly one a week.  So, if you figure out the odds of death, it comes to roughly one in 100.

Now, we know that nosocomial infection rates can be dramatically reduced. We are doing it…slowly.  We could go much faster, however, if we had a national Healthcare Patient Safety Reporting System in place.  We also know that the rate of such infections rate varies considerably from hospital to hospital.  If we had a national Healthcare Patient Safety Reporting System in place, we could learn from one another.  We could identify best practices.  We could be like the airplanes – a relatively safer place to be than it was back in 1976 when the aviation safety reporting system was first put in place.

More importantly, hospital acquired infections are just one problem!!  Imagine if we “reported” all incidents and all problems in healthcare?  Imagine if we were like the airline industry and had a “healthcare patient safety reporting system?”  You would all volunteer to be admitted to the hospital…  Let’s see: one in 20 million as a change of death by flying an airplane today or 1 in 100, as a result of being admitted to the hospital.  My friends – which would you rather do today?

We have the capability.  There is a way.  We need the will. Now is the time.