Hospital Challenges Threaten Healthcare Goals: HAIs, Litigations, Misdiagnosis - Research Paper

Introduction

The organization has been facing challenges such as high rates of readmissions, patient injuries, medical malpractices, and hospital-acquired infections. The situation has threatened to compromise the hospital's ability to reach its healthcare goals and mission. Currently, the number of patients diagnosed with HAIs has surpassed the thereat level prompting often dragging the organization into litigations. On the other hand, medical malpractices such as misdiagnosis, erroneous prescriptions, and inappropriate surgeries have led to increased operating costs due to patient compensation and litigations. Health care risks can affect an organizations' ability to provide primary care, which results in poor public reputation, legal injunctions, or even closure by state health agencies. Currently, the hospital does not have an updated risk management system, which has contributed largely to its misfortunes. According to Zuccotti et al. (2014), a clinical decision support system (CDS) can be utilized to aid hospitals to enhance healthcare quality and promote patient safety. A CDS also affects directly the ability of an institution to mitigate risks by reducing medical errors related to communication, diagnosis, prescriptions, and test interpretation (Zuccotti et al., 2014).

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The hospital aims to the CDSS in both inpatient and outpatient clinical settings. In this case, the organization recognizes that most claims arise from inpatient malpractices. According to Zuccotti et al. (2014), inpatient settings account for about 43.1% of cases, while outpatient claims account for 47.6%. For instance, patients who get injured in the hospital due to physician negligence end up being paid significant amounts of money. The situation increases the cost of health care. Additionally, most outpatient patients may unable to monitor their health progress, which results in high cases of readmissions. Therefore, since the risk management CDSS can be accessed remotely, it can aid in remote monitoring of patients' health, making it possible to apply timely interventions to minimize new infections.

Impacted End Users

The RL6:Risk system will impact physicians, hospital staff, nurses, billing officers, patients, and their families. Physicians and nurses are the primary users of the proposed users since they are involved in provision of primary care alongside enhancing patient safety. A study conducted by Zuccotti et al. (2014), shows that about 7.4% physicians are involved in malpractice claims annually, while 1.6% make compensations for the litigations. Therefore, by minimizing the risks posed by physicians, a hospital can reduce the costs of care associated with settlements, arbitration, or readmissions. Noticeably, physicians in the emergency room will be largely impacted by RD6:Risk software. The ER receives urgent medical cases, which sometimes may cause confusion s that may lead to misdiagnosis or inaccurate admissions. Additionally, physicians can utilize reports and data analytics from the system to predict the occurrence of infections such as sepsis. According to Amland and Hahn-Cover, (2014), CDSSs can be integrated with sepsis screening tools to aid nurses in identification of early signs and development of interventions to minimize the infection, which has a high in-patient mortality rate.

On the other hand, clinical systems such as radiology and laboratories will be impacted positively by the implementation of the system. Technical errors arising from these departments have a colossal negative effect on diagnosis or treatment of a patient. For instance, a laboratory specialist may fail to record crucial information in the HER or fail to carry out a specific test accurately, leading to inappropriate diagnosis. However, with the CDS, the departments can utilize alerts and notifications to correct their mistakes.

Breakdown of the Workflow

Typically, physicians are concerned with the provision of primary care and safeguarding of patient safety. In the absence of risk management software, they carry out risk management and forecasting manually, which is a tedious activity. Firstly, they carry out a risk assessment throughout the hospital to identify potential risks that may harm patients and staff. Secondly, through evidence-based research, physicians determine the probable causes and probability of occurrence for all the identified risks. Thirdly, doctors research for appropriate remedies for the threats to assist in minimizing casualties in case it occurred. Fourthly, physicians have to observe patients' progress relative to the risk board to determine, which threat is facing the patient. Unluckily, manual risk management is often reactive since physicians respond to the threat once it has occurred and try to minimize its adverse effects. Manual risk management does not permit predictability and it is not specific to given patient.

However, the RL6:Risk software allows personalized risk management and permits physicians to be proactive in dealing with impending risks. In this case, the software is integrated with the EHR system where it collects health data concerning specific patients. The data allows is analyzed and interpreted by specific algorithms to determine the probability of specific risks and identify their threat level. The software then issues data reports, conclusions or alerts to notify physicians on the likelihood of a specific incident, which allows doctors to apply appropriate interventions to minimize the chances of occurrence.

Project's Key Stakeholders

Firstly, the support of end-users, who are the primary stakeholders, is necessary to facilitate the successful implementation of the product (Kumar, 2016). Every user desires to have a system that serves the required needs and provides accurate results. End-users are important since they determine the organization will adopt the plan or not. For instance, end-users must identify that the system is reliable and efficient before accepting its implementation. Their approval reveals that they are ready to implement it and optimize its benefits (Jacob et al., 2017). Secondly, the procurement department is an interesting stakeholder in the process given that they are concerned with purchasing reliable products at a reasonable price. The procurement team must be convinced that the product's benefit will surpass those of the already existing infrastructure in order to make a decision on whether to buy it at specific price. They also have to determine the feasibility and viability of the product such as its subscription fees. They also check whether there is another functional competing software in the market. Thirdly, the hospital's system maintenance team has to asses if the proposed system can be integrated with other information systems.

Competing Solutions

The market has several competing risk management software that offers different specifications. Examples include Quantros Safety Suite, Ability Riskwatch, Converge, and 360 Total Solutions. However, the competing applications are not user-friendly because they have a confusing user interface. Additionally, their prescription fees are costly and often require users to input data to help the systems in predicting the risks. However, RD6:Risk software offers a wide variety of features, which can be integrated into all hospital settings, making it more effective than its competitors. Notably, the American Health Association recommended it for use in healthcare risk management in the United States ("AHA endorsement," 2019).Implementation Approach

Key Champions for Change

Implementation champions are individuals who believe in the desired change and engage in change advocacy. The key champions will include dedicated clinicians, nurses, information technologists, and nursing managers (Shaw et al., 2013). The individuals will promote the adoption of the system from within the organization. A clinician champion can rally the support of fellow peers in adopting the system by illustrating its benefits to them. Additionally, nursing managers can advocate the change and drive their teams through successful implementation. They should have passion, believe in the change, and motivate their units towards the change (Jacob et al., 2017). Chief nursing officers should be on the frontline in enhancing a change mindset among clinicians. Leaders play an important role in planning and managing the implementation process. They engage all stakeholders, keep them focused and motivated, and develop a feedback mechanism to facilitate program implementation.

Implementation Risks and Mitigation methods

Cultural notions serve as resistance to organizational change. People are often accustomed to their conventional ways, making them reluctant to adopt new ideas. The reluctance may be caused by the staff's experience with a failed system or change plan, which makes them have a poor attitude. On the other hand, cultural notions, for example, when employees think that automation will lender them jobless, negatively influences implementation of a program (Moji et al., 2014). The problem can be maneuvered by implementing the project in phases to allow incremental changes that enhance an organization's credibility. Secondly, the threat of forcing change can affect the successful implementation of the initiative. Forcing change occurs when an organization implements change without involving all appropriate stakeholders. Instead, the organization can identify champions at each level or clinical microsystem in the hospital to educate others and garner their support towards the change (Moji et al., 2014). The situation allows all stakeholders to be aware of what is required of them and the benefits associated with the desired initiative. Thirdly, lack of proper management may hinder the successful implementation of the CDSS. The management should be competent in ensuring that the project is rolled out as planned and be quick to resolve any challenges effectively. Additionally, the management should ensure that employees are trained concerning how to utilize the system.

Data Sources

Data will be sourced from existing hospital information systems and manual records. The EHR will be the primary data source because it contains significant data concerning the patient's care process. The organization is equipped with an EPIC EHR system that will provide the application with a patient's medical, prescription, diagnosis, and history. Remote patient monitoring software (RPM) will also provide vital data concerning outpatient patients. RPMs are capable of transmitting an individual's data to healthcare professionals remotely. They often monitor blood pressure and blood glucose levels to assist patients with chronic disorders to get access to emergency care. RL6:Risk can collect the information transmitted through the RPM, analyze it, and send an alarm to physicians concerning a potential risk.

Data extracted from the sources include reports, analysis, and predictions, which can be communicated via alarms or via notifications. Alarms signal a high-level risk that must be addressed immediately to reduce the risk from occurring. Noticeably, the collection of the data will be easy since all the RL6:Risk software can be integrated with other systems easily. Unlike in manual entry of data, the software's interoperability allows it to collect the required information from relevant sources to facilitate real-time protection of patient safety.