Meeting on technology and patient safety
Lord Darzi welcomed delegates to Imperial College. He spoke about his excitement for technology and this piece of work. Sir Liam Donaldson spoke about the work of WHO Patient Safety, describing it as a change management programme. He described an important interface between technology and patient safety, with technology working to make care safer, but at times introducing new risks. Professor Guang-Zhong Yang thanked the many delegates for attending, and reviewed the days objectives to understand the role of technology in patient safety, and consider future directions for the project. Pauline Philip expressed her thanks on behalf of WHO to Imperial College.
Raj Aggarwal presented an overview paper, which introduces a tool or method, to consider the role of technology in the clinical setting considering types of technology, errors and how technology can reduce errors, at a variety of stages on the pathway. A number of themes were emergent, such as improving communication between care domains and the role of technology in this. Most delegates agreed this was a reasonable approach, and could be used in a wide variety of clinical settings. An understanding of human behaviour, and how they interact with technology, was seen as important and perhaps under-recognised. For example, most error systems report device failure, but a far greater issue is poor device design which permits human error.
Richard Reznick presented an overview of simulation. Simulation is a versatile tool that can be used to train a wide variety of skills important for patient safety: team-work, communication and procedure skills. Simulation may involve high or low fidelity techniques, the later will be considerably cheaper. Two project proposals were presented: birthing simulation and hand-overs.
Introducing new technology safely
Adriana Velazquez presented on behalf of Enrique Ruelas. The life-cycle of technology from development to routine use is discussed, and the key role for regulation, health technology assessment, clinical engineering and surveillance in this life cycle considered. A distinction was made between contextually new and conceptually new technologies. Special consideration was given to the needs of developing countries. Two project recommendations were made: 1) developing regulation to promote the safer introduction of new technologies in the developing world, and 2) working to ensure design of technology was appropriate for the needs of developing countries.
Making existing technologies safer
Stuart Whittaker presented his group’s paper. Key areas covered including reporting and learning systems, classification of errors, and learning from the AIMS and COSHA. Two projects were put forward: 1) Determination of effective measures to implement technology services aimed at improving the procurement, maintenance and use of medical devices that are needed to provide safe quality clinical care for common conditions presenting at rural hospitals in developing countries using agreed standards supported by training and quality improvement methodologies; 2) Determining the cost implications of implementing integrated healthcare technology systems designed to enhance patient safety in rural healthcare facilities.
Azeem Majeed presented the work of his group – information technology was a broad area, and the group had chosen to focus on information transaction. Two messages were highlighted that evidence of usefulness for tools was limited, and that every tool confers new risk. Two projects proposals were put forward: 1) a forum for sharing best practice around IT, recognising the difficultly of realising the benefits of IT. The forum should share both successes and failures, to avoid repetition of past mistakes, and could be virtual to reduce costs; 2) a project to improve data quality, recognising that data is often missing, of poor quality, and lacks standardisation.
David Bates joined by phone and emphasised there was growing evidence for the efficacy of specific interventions, such as CPOE. Many of the IT issues were quality issues, as well as patient safety. Change management is key to improvements.
Delegates had marked the eight projects against a set of objective criteria, for example burden of the problem, and impact on patient safety. Birthing simulator and hand-overs scored the highest marks.
Delegates broke into four groups, chaired by the four group chairs, and discussed the strengths and weaknesses of each project. These were then fedback to the group, with further group discussion. Hand-overs, an intervention using simulation and a structured intervention tool, emerged as popular topic. This was seen as an important area globally, that was multi-professional and multi-disciplinary, and could be relatively cost effective project. The difficulty of achieving cultural change was emphasised, and the extent to which hand-overs fell within the remit of technology was questioned.
The results of a second round of voting were presented. Hand-overs emerged as the most popular choice. Ed Kelley fed back key points highlighted on the different projects.
Guang-Zhong reflected on a busy and exciting day of work. He thanked the delegates, staff at Imperial College and WHO.