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SAFETY in eHEALTH: The power of data and technology to build insight and resilience Neville Board RN, BA, MPH
Information Strategy Manager
SAFETY IN ACTION – SIA National Convention
27 March 2014
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Acknowledgements
Dr Niall Johnson, Australian Commission on Safety and Quality in Health Care
A/Prof Christine Jorm, Sydney University
Dr John Wakefield
(then) Executive Director, Queensland Patient Safety Centre
Australian Institue of Health and Welfare (AIHW)
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Health expenditure $140.2bn in 2011/12
$5,881 per person ($5711, in NSW to $8,512 in NT)
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! OVERVIEW
Australia’s Health 2012 (AIHW) p.473
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Can we measure this?
Thomas EJ, Petersen LA, Measuring errors and adverse event rates in health care, J Gen Intern Med 2003;18:61-67
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Device and procedural safety
Medication safety
Safety in eHealth
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MULTI-FACETED
P Davies, 2005, Evidence-based Policy at the Cabinet Office, Impact and Insight Seminar, Overseas Development Institute, 17 October 2005, London
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Source: A/Prof Christine Jorm, DIY Human Factors for Safety, Medical Device Safety Forum 2010
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Source: A/Prof Christine Jorm, DIY Human Factors for Safety, Medical Device Safety Forum 2010
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HUMAN FACTORS
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Wakefield, J, Better actions, better outcomes: Human Factors Engineering (HFE) and Strength of Actions, Medical Device Safety Forum 2010
Human factors engineering (HFE)
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Human factors engineering (HFE)
Wakefield, J, Better actions, better outcomes: Human Factors Engineering (HFE) and Strength of Actions, Medical Device Safety Forum 2010
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Human factors engineering (HFE)
Wakefield, J, Better actions, better outcomes: Human Factors Engineering (HFE) and Strength of Actions, Medical Device Safety Forum 2010
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LOW IMPACT
HIGH EFFORT
HIGH IMPACT
LOW EFFORT
X Training Written procedure X
Physical change X X IT system
Wakefield, J, Better actions, better outcomes: Human Factors Engineering (HFE) and Strength of Actions, Medical Device Safety Forum 2010
Human factors engineering (HFE)
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SYSTEMATIC
Systematic monitoring and review of a cohort of procedures/uses with measures of effort, complications, and outcomes allows a genuine safety assessment and generate evidence and lessons on procedure/device efficacy, safety and best-practice implementation.
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Application of clinical quality registries
Focus on • high-cost high-significance procedures • areas with known variation in outcomes or practice • economic case for improved outcomes.
Australian examples: • ANZDATA (renal) • National Joint Replacement Registry • ANZICS (intensive care) • ASCTS (cardiac surgery) • VSTORM (trauma)
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Registries – Example 1 NJRR
Joint replacement • National Joint Replacement Registry identified
sub-standard prostheses • Found significant differences in
outcome/need for revision • Over 4 years the proportion of
hip and knee procedures that are revisions has declined from 14.8 to 11.1% and from 10.4 to 7.9% respectively.
• These declines are in large part attributable to monitoring systems incorporated into the registry
• Annual cost saving ~ $44.6 million. The cost of running the Registry is $1.5 million per annum.
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Renal transplantation • Poor outcomes with transplantation lead to increased dialysis • Cost difference:
Transplantation: $15K p.a.; Dialysis $60K p.a. • ANZDATA registry has contributed substantially to improved
outcomes of renal transplantation (eg Perit Dial Int, 2007;27(2):184-191)
Registries – Example 2 ANZDATA
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Device and procedural safety
Medication safety
Safety in eHealth
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coUMADIN coVERSYL
cyclosPORIN cyclosERINE
DEPO-medrol SOLU-medrol
DEPO-medrol depo-PROVERA*
solu-CORTEF* SOLU-medrol
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SCOPING STUDY 2009
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Device and procedural safety
Medication safety
Safety in eHealth
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Source: A/Prof Christine Jorm, DIY Human Factors for Safety, Medical Device Safety Forum 2010
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HOW TO SCARE OFF YOUR HOSPITAL MANAGERS
DEATH BY ROI
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HOW TO SCARE OFF YOUR “BUSINESS”
DEATH BY PROJECT MANAGEMENT 101
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HOW TO SCARE OFF YOUR CLINICAL LEADS
DEATH BY PROJECT LIBRARY
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HOW TO SCARE OFF YOUR EXECUTIVE GOVERNANCE
DEATH BY SIGN-OFF
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Health Affairs, 30, no.3 (2011):464-471
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• choose a system that is intuitive to use and that requires
little training for users
• choose a system that can be modified and developed easily
• ensure that the decision-making process for developing
or selecting a system is participatory, but once this
decision has been taken ensure that implementation is directed
and driven.
These findings need to be tested in other settings to understand
the degree to which they are generalisable.
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