Quality is measured by the outcomes that matter to patients, and underlying patients’ total experience influencing patient outcomes is clinical effectiveness, Asian Hospital and Medical Centre (AHMC)’s Quality Management Director Dr Ana Maria Jimenez remarks. Critical in ensuring application of best knowledge from up-to-date evidence, clinical effectiveness helps “to achieve optimum processes and outcomes of care for patients”. As one of the Philippines’ most advanced healthcare institutions, AHMC strives to consistently work on its clinical effectiveness strategy.
Yet, Dr Jimenez admits that it is an uphill struggle. AHMC, for instance, faces several challenges in its goal to ensure patient safety. Primarily, the issue lies in insufficient references that are both reliable and accessible to help physicians make informed decisions. Added to this is the variability in care that significantly reduces efficiency.
According to the World Health Organisation (WHO), 4 in 10 patients globally do not receive proper treatment even though the harm they suffered could have been prevented. Should more physicians and hospitals have available clinical resources at their fingertips to help them properly diagnose these patients and provide them appropriate care, more lives could have been saved and more patients could have been satisfied with their healthcare experience.
Dr Jimenez points out that the lack of relevant resources is not only a struggle in providing point of care decisions, but also during morbidity and mortality case reviews, investigation of an adverse event, appropriateness review of drugs, adoption of clinical practice guidelines, pathways, bundles of care and/or protocols, and writing or reviewing policies on patient safety.
On a similar note, variability in care can create problems that could ruin outcomes improvement for any hospital. In 2016, for example, a hospital in Australia lost a patient due to medication overdose as he was given ten times the prescribed amount of an opioid painkiller. This happened due to the inconsistency of clinical knowledge between the physician and the nursing staff. In AHMC, at least 80% of patient safety events are related to outdated practices and lack of collaborative care among multidisciplinary team members, Dr Jimenez tells Hospital Insights Asia.
In today’s digital age when information can come from everywhere, more patients can suffer from a variation of care. Due to the massive amount of information now available, it can be difficult for physicians to make informed decisions in line with a patient’s needs.
To reduce variability, hospitals can consider using clinical decision support technologies. Considered as new opportunities to reinvent healthcare by enriching clinical effectiveness, such tools can reduce cost (i.e. lesser wasteful testing and reduced emergency room use) while improving the quality of care given to patients.
Committed to embracing “innovations in healthcare for an unforgettable healing experience”, AHMC consistently looks for ways to be on top of the game towards providing the best care for its patients. Two years ago, AHMC started using UpToDate, an evidence-based clinical resource by Wolters Kluwer. By and large, this move is meant to equip the staff with the most recent and reliable clinical information that can translate to standardised care and eventually better patient outcomes.
Dr Jimenez reveals that AHMC’s ICU Intensivists and Fellows are among the primary users of UpToDate. They discovered that this clinical resource is a helpful tool in their department as they examine drug information, find treatment recommendations, and give information to patients. In fact, AHMC finds a decreasing trend in the ICU standardised mortality ratio over the past two years since they have adopted UpToDate.
More recently, AHMC finds UpToDate really useful in their response to the COVID-19 emergency. The hospital’s Multidisciplinary Healthcare Team refers to UpToDate and its resources on the infection which are updated on a daily basis, says Dr Jimenez.
Thus far, Dr Jimenez sees UpToDate as a solution that supports AHMC’s goal to continuously ensure patient safety and enhance clinical effectiveness. Likewise, she believes that other hospitals can experience the same benefit from using UpToDate in line with evidence-based practices. Its ease of use, accessibility via mobile applications, organised and in-depth reviews, graphical presentations, link to LexiComp drug database, and use of GRADE approach for recommendations are just some of the features that Dr Jimenez believes would directly help hospitals optimise this tool to provide topnotch care for patients.
It is definitely looking way ahead to say that evidence-based practice might lower the number of adverse events from unsafe care that can be preventable with the presence of sufficient and tailored resources to support clinical decisions. Still, a decrease in mortality and an increase in satisfied patients are something the healthcare industry remains optimistic about.
Improving quality of care may be an expensive venture. Nonetheless, the failure to seek improvement in care can be even more expensive. After all, the WHO recognises how “investments in reducing patient harm can lead to significant financial savings, and more importantly better patient outcomes”.#
An evidence-based clinical decision support solution used by more than 1.7 million clinicians in 190+ countries to make important day-to-day clinical decisions, UpToDate is the only resource associated with improved patient outcomes and hospital performance, and studies show that clinicians who use UpToDate change their decisions 30 percent of the time. More than 6,900 world-renowned physician authors, editors, and reviewers use a rigorous editorial process to synthesize the most recent medical information into trusted, evidence-based recommendations. Every day, clinicians view topics covering 25 specialties over 1.5 million times.
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