April 12, 2016

3 Ways Scribes Support a Culture of Safety

Since the Affordable Care Act linked financial rewards to a number of patient-safety measures in 2010, the incidence of preventable errors that harm patients has declined by 17%. What’s more, reductions in preventable infections, pressure ulcers, adverse drug events and other preventable harms saved nearly $20 billion in healthcare costs, according to the Department of Health and Human Services (HHS).

Those savings benefit everyone, across the healthcare system, making reimbursement systems (particularly Medicare and Medicaid) more sustainable for the long term, and freeing up capital for hospitals to invest in other projects that will enhance efficiency and value. However, although the incidence of preventable errors dropped between 2010 and 2014, the decrease leveled off over 2013 to 2014. As it’s highly unlikely we’ve reached a point of peak patient safety, there’s more work to be done — not just in targeted efforts, but in supporting an overall culture of safety.

Elements of a culture of safety

We know that a culture of safety greatly influences overall quality of patient care, and yet, this fundamental building block of healthcare remains undervalued and overlooked when compared with technological factors. A study recently published by the Journal of the American College of Surgeons found that non-technical, organizational aspects of care affected whether surgical site infections (SSIs) developed after colon surgery. Researchers from Johns Hopkins University School of Medicine in Baltimore tracked colon surgery cases at seven hospitals in Minnesota and found that “9 of 12 dimensions of surgical unit safety culture were significantly associated with lower colon SSI rates.” Among those factors: teamwork across units, teamwork within units, communication openness, and feedback and communication about error. Using medical scribes supports these elements, helping to create a perception among patients and clinicians that safety is taken seriously in a busy and buzzing hospital. Here’s a closer look at three ways scribes support a culture of safety.

1. Focus on patients

A culture of safety starts with making care more patient-centered. A recent article in the Sacramento Bee opened like this: “Dr. Arthur Jey shepherded a middle-aged female patient, hunched over in pain, from the Sutter General emergency waiting area to a nearby exam room – wrapping an arm around her back as he placed her gently in a chair. He knelt on the hospital floor as he examined her aching abdomen and asked about her health history.” When was the last time you or your docs were able to give a patient your undivided attention in this way? Dr. Jey had the benefit of a medical scribe working to document the patient encounter so he could create an openness of communication with the patient. Opening channels of communication ensures that physicians get the full story from the patient, so they can more effectively order tests, diagnose issues and develop treatment plans. What’s more, when physicians aren’t multi-tasking, they’re less likely to make mistakes — such as ordering the wrong drugs — that can result in preventable adverse events.

2. Joining up communication

In busy surgical and emergency departments in particular, there are a lot of moving parts to manage. Pharmacy, diagnostics, physicians, nurses, allied health professionals and more are all working to efficiently move patients through without compromising quality of care. Certified medical scribes can be tasked with delivering messages between providers, and to patients and their families, from the physician. In addition, a scribe can help the physician stay focused on the task at hand by recording notes from the tech, nurse, or another department. This lets the doctor manage new requests in order of actual priority, rather than the order in which they are delivered — and ensures the care plan for the patient in the room is executed in a timely manner. The scribe can also play a critical role in keeping the physician on track to revisit patients or follow up on test results. If the physician wants to see a patient again in 30 minutes or get a report back from radiology or the lab, the scribe can track the time and provide reminders. All these efforts enhance teamwork and keep the communication within and between departments flowing, so that there aren’t missed messages or miscommunications that could lead to preventable harms.

3. Minimizing and tracking errors

As noted, when physicians aren’t forced to bounce back and forth between patient and computer — that is, they’re able to focus on the job they’ve trained for — they’re less likely to make mistakes that could harm patients. But consider that, when not in the exam room transcribing physician observations about patients in real time, scribes are entering patient data into electronic health records (EHRs), the result is an accurate record of the entire patient encounter. Documentation of this caliber is absolutely vital to tracking errors and finding patterns, in order to understand how mistakes happen. Without a thorough patient record in the EHR, you can’t get the understanding necessary to develop strategies for change. Human error cannot be eliminated entirely, but it can be minimized through systems change. A culture of safety relies on feedback and communication about errors, and implementation of non-punitive responses to error — which starts with accurate documentation created by scribes.

From the top down

The study by the Johns Hopkins researchers also pointed to organizational learning, overall perceptions of safety, management support for patient safety, and supervisor/manager expectations and actions promoting safety as having significant impacts on reducing preventable harms. The takeaway: When hospital administration takes patient safety seriously, everyone else will, too.