How SAFER Guides Improve Patient Safety and Medical Risk Management

Incorporating new practices recommended by the Center for Medicare & Medicaid Services (“CMS”) SAFER guidance into your electronic health record (“EHR”) system setup can yield substantial benefits beyond compliance. . These recommendations represent a roadmap for reducing errors in patient care, leading to reduced patient harm, medical malpractice, and other financial risks.

Of the nine SAFER guides, the four “Clinical Process Guides” (#6-9) include many powerful countermeasures that can be applied across the continuum of care. They focus on patient assessment, diagnostic decision-making, ordering and interpreting tests, and monitoring provider/provider communications.

While the new CMS requirements require an annual self-attestation indicating whether you have followed each specific recommendation, there is currently no penalty associated with a negative response. However, devoting the time and resources to meeting the recommendations of the SAFER guide can fill critical gaps in your organization’s patient safety process and program.

This can provide a potential competitive advantage by reducing harm to patients, limiting exposure to medical liability, increasing clinician and staff confidence and satisfaction, and protecting your organization’s brand in the marketplace.

Where malpractice claims occur in the care process

Throughout the delivery of patient care, there are many areas of risk that can be mitigated by optimizing your EHR system, as shown in Table 1. The left column lists a typical 12-step “patient journey.” The right column contains the frequency, each discrete step of which is associated with medical malpractice claims from a white paper published by CRICO, the malpractice and risk prevention research arm of Harvard Hospital Systems. Data was drawn from a nationwide cohort of high-performing hospitals that contribute cases to CRICO’s Comparative Claims Database:

Stage of the care process % of malpractice cases
1. Patient notes problem and seeks care 1%
2. History/Physics 8%
3. Patient Assessment/Symptom Assessment 31%
4. Diagnostic treatment 35%
5. Order of diagnosis/laboratory test 31%
6. Execution of the tests 3%
7. Test interpretation 23%
8. Receipt/transmission of test results (to supplier) 5%
9. Medical follow-up with the patient 18%
10. Reference management 21%
11. Supplier-to-supplier communication 12%
12. Patient adherence to the follow-up plan 17%

Table 1: Mapping of the care process with associated frequency of medical claims.

Where the SAFER guides have an impact on patient safety:

Each recommendation in the SAFER guide can impact more than one step in the care process, multiplying its effect in preventing patient harm and reducing financial risk. The table below maps two example recommendations from each of the four SAFER Clinical Process Guides and links these recommendations to the individual step or steps in the care process that can lead to improved safety and reduced risk through its implementation.

Table 2 shows examples that demonstrate the link between the recommendations of the SAFER clinical process guide and the reduction of common medical errors throughout the patient journey. The powerful risk and safety countermeasures contained in SAFER Clinical Process Guides can help your organization reduce patient harm and financial risk associated with errors in the delivery of care. These improvements can translate into competitive advantage through reduced patient harm, reduced financial risk and increased staff satisfaction.

SAFER Clinical Process Guide Safer Recommended Practice Impact of the stage of the care process
#6 Patient identification An enterprise-wide master patient index that includes patient demographic information and medical record number(s) from different parts of the same organization to identify patients. 1, 5, 6, 8, 10
#6 Patient identification The information required to accurately identify the patient is clearly displayed on all computer screens, wristbands and printouts. 5, 7, 8, 9, 11
#7 Computerized entry of supplier orders with decision support Coded allergen and reaction information, or no known allergy (“NKA”), is entered and updated in the EHR prior to any order entry. 2, 4, 5, 9
#7 Computerized entry of supplier orders with decision support Evidence-based prescription sets are available in the EHR for common tasks/conditions and are updated regularly. 5
#8 Report and track test results Workflows particularly vulnerable to mismanagement of test results, especially the most critical ones, are identified. Back-up procedures ensure that test results are received by a person responsible for the care of the affected patient. 5, 6, 8, 9
#8 Report and track test results Automated, non-interrupting result notifications (also known as alerts or in-cart flags) are limited to those that are clinically relevant to minimize alert fatigue. 3, 4, 11
#9 Clinician Communication Workflows particularly vulnerable to mismanagement of test results, especially the most critical ones, are identified. Back-up procedures ensure that test results are received by a person responsible for the care of the affected patient. 5, 6, 8, 9
#9 Clinician Communication Automated, non-interrupting result notifications (also known as alerts or in-cart flags) are limited to those that are clinically relevant to minimize alert fatigue. 3, 4, 11

Table 2: Prospective impact on the process of care of implementing sample recommendations from the SAFER clinical process guides, issues 6-9.

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