Category: Blog

EMER: How consumers & clinicians can improve patient experiences in Hospital Emergency Departments

1 in 10 diagnoses made by a doctor, is thought to be incorrect. It is estimated that each year in Australia 8,000 patients die from medical error. 300,000 hospital admissions are associated with potentially preventable adverse events. The Emergency Medicine Events Register otherwise known as EMER, was developed so that consumers and clinicians could report adverse incidents. To allow clinicians to learn from their mistakes and create an open culture of discussing patient safety.

 

Speaking at ‘Organisational Approaches to Implementing Patient Experience: Lunch Box Session’ from EMER are Anita Deakin and Dr Carmel Crock (Royal Victorian Eye and Ear Hospital & ACEM). ‘EMER is an adverse event and near-miss reporting system that is peer-led, online, anonymous and confidential. It is a means of supporting improvement in safety and quality in emergency medicine by understanding of contributing factors and how the risk of harm to patients can be minimised or prevented.’ (emer.org.au)

 

An important factor to practice improvement in the Emergency Department (ED) requires hearing about the care experiences of patients and their family member or carer. Their experience and perspective (whether it be good or bad) is a key aspect to ensuring patient safety and high quality care in all areas of health care. It is important that health care staff are able to learn from consumer’s experiences to ensure they are providing the best quality of safe health care.

 

The following is an interview with Anita Deakin and Dr Carmel Crock:

Why did EMER consider consumer reporting?

Patients have a very different perspective to medical professionals – they see things that we don’t necessarily see and they are an essential part of the team. The patient voice is extremely important and has often been overlooked in patient safety endeavors.

 

What involvement did consumers have in developing EMER?

From the inception of EMER we have had a consumer advocate on the Steering Group. Every step of the way we have considered how EMER could benefit consumers and how best we could engage them in the process. When we decided to introduce a consumer portal into EMER we involved consumers in developing the content and in testing it.

 

How does EMER improve patient experiences?

We are hoping it will improve patient experience by changing the culture of emergency medicine to openly discuss patient safety concerns within the specialty. We want to hear the patient’s voice.

 

Once the data has been collected, compiled and analysed, are the findings conveyed to the health services to facilitate system change in health care?

Once the data has been collected, compiled and analysed the findings are fed back to the specialty so that trainees and specialists get to hear about the types of incidents that are occurring in Emergency Departments. Some of the ways that we provide feedback is by writing patient safety alerts, journal articles and conference presentations both nationally and internationally.

 

If so what mechanism is used to facilitate system improvements?​

We look for patterns or “common themes” within the incidents reported and feed this information back to the Australasian College for Emergency Medicine (ACEM) that is responsible for training emergency medicine specialists. In this way the college is able to address these themes in their education and training.

 

Why is it important that consumers report these adverse incidents and what benefit they get by reporting them? Why did EMER think it was important to include consumers in the reporting of incidents? I understand that this is revolutionary and that nothing similar is being conducted elsewhere.

 It is important for consumers to report adverse events so that system changes can be made to make Emergency Departments safer for all involved. Often consumers see things that clinicians aren’t aware of, or see it from a different perspective. The consumer and the clinicians are both essential team members in the patient safety quest.

 

The EMER model works in the following way:

Identify – Report – Improve

Identify risks to patient safety

The types of errors that EMER want reported into the system are any incident in the emergency department that either did cause harm or could have caused harm to a patient. This would include things such as diagnostic error, errors around procedures, medication error, errors around clinical handover and safe transfer of patients from the emergency department.

EMER records the serious incidents, but also near misses, good saves, and adverse events. Collecting near misses is very important because for every adverse event there are 10 near misses.

EMER want Emergency doctors and nurses to discuss error openly, they want them to think about patient safety, to think about how things could be done better. To discuss incidents with their supervisors, with medical students, with nurses, to create an open culture of discussing patient safety and error.

Report – Report adverse events and near misses.

The anonymous online system is easy to use and only requires five minutes to enter the incident. Everyone involved with the incident from the consumer to the clinician are able to enter the information required.

When the information is collected it is classified using the Advanced Incident Management System (AIMS), a tool that was used to develop the international classification for patient safety.

Improve – Inform clinical practice and system change

EMER provide immediate feedback to those who report an incident. Once they have read the report it takes them to a thank you page which provide information about the incident which includes a simple graphical representation of the data. It also includes an incident of the month, which provides users an example of what other people are reporting and information that is of interest to the research team.

Once the incidents have been classified using the Advanced Incident Management System (AIMS), specialists from multi-disciplinary groups then review the incidents to determine how they could have been prevented.

To find out more EMER register for the free session ‘Organisational Approaches to Implementing Patient Experience: Lunch Box Session’ on Thursday April 28, 2016. Sponsored by Illuminance Solutions and Empower ICT.

 

Sources:

  • Anita Deakin
  • Dr Carmel Crock, Royal Victorian Eye and Ear Hospital & ACEM

 

Slim chance of losing lots of weight

If you are obese your chances of achieving normal weight without surgery are slim to put it mildly. If you are male, you have a chance of one in 210. Women fare a little better; their chances are one in 124. These depressing statistics come from a ten-year study of 77,000 obese men and 100,00 obese women in the UK. To compound this picture at least half of those who managed to lose substantial amounts of weight put it back on within five years. No wonder the diet and gym industry is booming.

 

Dr Simon Rosenbaum, national director of Exercise and Sports Science Australia, writing in The Conversation says weight loss important but fitness, not fatness is a better focus. He says many people who start an exercise program to lose weight are setting themselves up to fail because exercise in the absence of dietary modification is not all that effective for weight loss.

 

An online survey carried out by CSIRO says Australians are their own worst enemies when it comes to eating better and controlling their weight. The survey, which looked at the weight management habits of more than 2300 Australians, found 69 per cent of respondents identified themselves as the main barrier to achieving their weight loss goals. CSIRO’s Research Director for Nutrition and Health, Professor Manny Noakes said it was critical that those looking to lose weight seek support.

 

“For many Australians losing weight is a challenging experience. The survey also showed that 40 per cent of dieters stated that no one supports them in their weight loss attempts.”

“Health professionals, friends and family can all play a role in helping dieters eat better and control their weight.”

 

The good news for seniors is that being overweight (but not obese) is not a health hazard. Ms Ngaire Hobbins – a dietician who specialises in the care of older Australians – warns that a healthy weight once you are over 65 is not necessarily the same as applies for younger adults. She says a Body Mass Index (BMI) between 23 and 28 is probably ideal for older adults. Being thin in older age is associated with a higher likelihood of dementia, of having a fall, of general poor health and even death. Those who are a bit heavier fare best. Ms Hobbins’ conclusions are supported by researchers at the University of Western Australia.

 

They studied over 12,000 Perth men selected at random from the electoral roll. All were between the ages of 65 and 84 and had no symptoms of dementia.  Overweight – but not obese – older men were healthier than either their slimmer or fatter colleagues. “We are struggling to explain the results,” said Leon Flicker, Professor of Geriatric Medicine and one of the study authors. “Being overweight after 70 doesn’t have the same negative effects that it does in younger men.” “Men over 70 and in reasonably health good health but overweight, are less likely to develop dementia. Exactly why we don’t know. We can speculate that fat tissue may have some important protective role in older men or it may build some resilience into the system.”

Dr Rosenbaum says exercise is important, but for other reasons. It helps protect against developing chronic diseases, such as type 2 diabetes, even for people who are obese.

 

By Frank Smith – HCC Blog Contributor

Patient Experience Week is Launched!

Patient Experience Week Event Series_Poster

In 2015 the Health Consumers’ Council took the decision to begin a tradition of running events during the global Patient Experience Week which takes place annually in the last week of April. We have also shifted our Consumer Excellence Awards to close Patient Experience Week rather than being held at Christmas.

We are very excited to be able to build on the momentum of the National Safety and Quality Health Service Standards, Partnering with Consumers, the current environment of change, reform and re-focus on the patient by bringing you our inaugural Patient Experience Week Event series on Thursday 28 and Friday 29 April. Highlights include; new author Kate Ryder talking about her book, ‘An Insider’s Guide to Getting the Best out of the Health System’ (Kate will have signed copies of her book available for purchase). Professor Michael Greco, Patient Opinion Australia CEO; Dr Karen Luxford, Clinical Excellence Commission of New South Wales, Director of Patient Based Care; Professor Anne Williams, Murdoch University, Chair of Health Research and Helen Fernando, Consumer Advocate and ‘Patients for Patient Safety’ champion, will present on the latest and best patient experience tools. Click here to book your events now!

Patient Experience Week is an initiative of the Beryl Institute. It is an annual event to celebrate healthcare staff impacting patient experience every day. Inspired by members of the Institute community, Patient Experience Week provides a focused time for organisations to celebrate accomplishments, re-energise efforts and honour the people who impact patient experience every day. From nurses and physicians, to support staff and executive professionals, to patients, families and communities served, the Institute hopes to bring together healthcare organisations across the globe to observe Patient Experience Week.

Patient Experience Week will close with the annual Health Consumers’ Council Health Consumer Excellence Awards. Since 1997 the Health Consumers’ Council has been celebrating the achievements of the unsung heroes in WA Health, from the administrator to the clinician and to recognise health consumers that go out of their way to make a difference. Nominations are now open, and close on April 15th, 2016.

You can always call (08) 9221 3422 or email info@hconc.org.au for more information.  Find us on Facebook or Twitter. Hash tag #hconcwa_PatientExpWk16

Your Say on Cancer WA

A recent state-wide survey shows that many people don’t know that 30 – 40% of cancer cases in WA are preventable. With almost 12, 000 Western Australians diagnosed with cancer every year, this is both shocking and heartbreaking.

 

This information comes from a report recently released by the Department of Health entitled Priorities and Preferences for Cancer Control in Western Australia

 

This report summarises responses to an online public consultation conducted last year on the seven cancers which have the greatest impact on the WA community and greatest opportunity for prevention: bowel, breast, cervical, lung, melanoma, prostate and oesophageal/stomach cancer. The report has revealed that a third of participants were unaware that much could be done to prevent cancer.  In particular, many people were not aware of the dietary risk factors for bowel cancer and that cervical cancer is almost entirely preventable.

 

A poor understanding of the preventability of cancer is not necessarily surprising as historically, much of the discussion about cancer in the community has focused on treatment, sometimes to the detriment of prevention messages.  However, it does highlight the potential for reducing the pain, anguish and cost associated with treating cancer.

 

The value of this new report is that, in seeking out community views on priorities and preferences for cancer control it has identified some clear areas for increased action in the immediate future, including: Increasing the number of Western Australians participating in the National Bowel Cancer Screening Program; Strengthening health promotion messages around recommended red meat intake; reducing processed meat consumption; reducing alcohol consumption; and reducing salt intake, as well as links between obesity and cancer risk; Working to raise the profile of cancer prevention and early detection; and Building on gains made in tackling harm caused by smoking, exposure to ultra violet radiation and asbestos, as well as exploring new and innovative programs to reach vulnerable groups and address emerging issues.

 

This is the first time the Chief Health Officer of WA has asked the community for feedback in a report and the first time (to my knowledge) an online forum has been used to gather community opinion on cancer prevention in WA. As a co-author on the report it was a privilege to bear witness to the frank, open and creative ideas for cancer prevention from our consultation participants.  We are very grateful for their input and the time they devoted to answering our questions.

 

The report was prepared in collaboration with a number of agencies including the Health Consumers’ Council WA, Cancer Council WA, Public Health Advocacy Institute of WA, Curtin University and WA Clinical Oncology Group.

 

To read more about the findings of the consultation and how the Department of Health is responding, you can access the full report here:

 

www.healthywa.wa.gov.au/~/media/Files/HealthyWA/Original/Your-say-on-cancer-wa/13009-chief-health-officer-report.ashx

 

As a project team we also had a lot of fun planning and putting together a consumer website with a range of supporting material including a summary of the report findings, some innovative infographics of cancer data, and expert videos.

 

Check out the website for yourselves here:

www.healthywa.wa.gov.au/yoursayoncancerwa

Guest Blogger: Dr Jennifer Girschik

Pap smear costs- a storm in a teacup?

The announcement slipped in easily enough just before Christmas. On December 15, in its mid-year budget update, the Federal Government announced that they would scrap the incentive payments for pathologists for bulk billing of tests, because the rate of bulk billing had not increased. In other words, the measure appeared to have failed.

This announcement reflects the work being undertaken in the Medicare Benefit Schedule (MBS) reform process which was established in April 2015. The MBS is a list of more than 5,500 item numbers against which medical practitioners can bill the federal government for payment. It is the basis of business models for public, private and not for profit health services. It includes clinical items as well as this type of incentive payment.

Queue then the entrance of the Royal College of Pathologists, and the Australian Medical Association. In other words, organisations whose bottom line is affected by this change. In some online and newspaper reports, figures were put on the cost to consumers of a pap smear  at around $30. On 6th January an article appeared on Mamma Mia’s website, and a petition about the cost of Pap Smears and pathology tests was launched by Change.org. Signatures are nudging very close to 150,000, and rising as this blog is being written. Yet the incentive payment being scrapped was in the region of $1.30-$1.40 according to the Federal Government. In the short discussion I just had with the media spokesperson for the College of Pathologists, the position of the College seems to be a reluctance to nominate an actual figure to be passed onto consumers. So is this an issue, or isn’t it?

I would venture to suggest that it is not. Change is always a difficult phenomenon to manage, and communication seems to have contributed to the backlash the Federal Government is experiencing. The real story is the reason behind the MBS Review and why it is so important for Australians that this happens. Here are some terrifying facts and figures about the MBS provided by our national body The Consumers Health Forum:

  • Until 1 January 2010, there was no clear process for adding new items to the MBS.
  • There was also no clear, consistent system for identifying and removing items from the MBS when they were no longer considered best practice or effective.
  • There was no consistent and formal process in place to test or review items already on the MBS, or new items coming onto it, to ensure they were doing what they were intended to do and were safe and cost effective.
  • Only three percent of items have been assessed for safety, effectiveness and cost-effectiveness. 

You read that right. Only three percent.

So the MBS Review team are carrying on their work, amidst the media cacophony. They are still very keen to hear from the community, but many people find the topic inaccessible and can fail to see how this may affect them. Perhaps this controversy will raise awareness of this enormous and much-needed reform currently unfolding. It is unfortunate that this Review is always going to get caught up in economic rationalist arguments and the undeniable need for our country to reduce its health costs. Public scrutiny will be important to ensure that the focus is on eradicating inefficiencies, duplication and waste rather than diminishing access to quality health services. But let’s ensure that this is a patient centred discussion, not a vested interest centred discussion.

Just before Christmas the MBS Review Taskforce released a new consultation has to look at obsolete MBS items, with feedback invited until 8th February 2016. If you are brave to work your way through the consultation documents, feel free to have your say.

Written by Pip Brennan, Executive Director of the Health Consumers’ Council of WA.

 

The cigarette packet that stops you smoking

All cigarette packets now carry warnings and graphic images to remind you of the dangers of smoking. Now Edith Cowan University and Curtin University researchers have gone a step further. They have built a cigarette packet that talks to you.

The cigarette packet is a plastic case for smokers to keep their cigarettes or nicotine-replacement products. The box is equipped with a speaker and microphone.

Smokers can record their own voice (or that of their loved ones) reminding them of the reason they want to quit. This plays every time the packet is opened.

Associate Professor Paul Chang from ECU’s School of Psychology and Social Science said the idea was to tap into the smoker’s own motivations for quitting.

“So far we have no widespread data, but we have tried the box out on clients of one pharmacy with good results. If you are a confirmed smoker with no intention of quitting you will have no interest in the device. But people who have already tried and failed to quit find it is a really good add on to change behaviour. It is very important for people to have their own personal motivation to do so,” he said.

Every time they open the packet it will give them a powerful motivation to quit once and for all.

“The message should give personalised reasons to quit that are important to the smoker, such as promises they made to themselves, their spouse or their children.”

“One thing I think that could be particularly effective for parents who smoke would be to get their children to record the message, encouraging them to kick the habit.”

Study participant Cathy Skalski said she had reduced the number of cigarettes she was smoking since she started using the packet.

“I have a recording of my two-week old grandson crying on my packet,” she said.

“It’s a great reminder for me of why I want to quit, so I can watch him grow up.”

Ms Skalski said having the sound play every time she opened her cigarette packet was embarrassing. That is a further incentive to reduce her smoking.

“I don’t like people looking at me when they hear the sound of a baby crying when I open the pack, which is good because it means I’m less likely to reach for a cigarette,” she said.

Professor Chang said the next step for the research was to use the data from the study to design a larger randomised control trial.

Professor Chang is currently looking for volunteers.If you are a smoker and want to stop but are finding it difficult to quit, leave a message on 6304 5745 or send an email to: p.chang@ecu.edu.au

By Frank Smith – HCC Blog Contributor

Wasted – did you watch this?

Wasted

Did you watch the Four Corners episode Wasted on waste in health care last night? It is highly recommended viewing and made a number of interesting points:

  1. That our Medicare Benefits Schedule (MBS) pays an amount to a health care provider every time they provide a test or treatment. This provides a perverse incentive for medical practitioners to offer more tests and treatments. And more does not always equal better.
  2. That up until the last five years, procedures were not subjected to an evidence base test before being added to the MBS. Which means there are several decades worth of procedures on the MBS that do not pass the evidence base test.
  3. That there is no connection easily made between the number of treatments done and the health outcomes they are achieving for us. So while data is collected from MBS, from our hospitals and health services, from our diagnostic services, this data is collected in silos and cannot easily be translated into a coherent picture of what works, and what doesn’t
  4. That health consumers are sometimes asking for diagnostic procedures and treatments on the understanding that this will ensure they a) reduce their worries and concerns and b) they will get better.
  5. That it takes time in a clinical consultation to explain why tests and treatments may not actually achieve the outcome the consumer is seeking, and spending more time discussing and explaining treatments and options with consumers is not financially rewarded.

At one point consumers are encouraged to ask questions in order to feel sure that the treatment they are having will a) be useful and b) won’t potentially harm them and c) won’t waste our precious resources. A key question is “what’s the evidence for that?”

The imagery throughout the episode of the journey we all face through the different systems once a test is ordered highlights how important it is for us to get on the train knowing exactly where we may end up.

If you have a body and have ever been to a GP, then this story affects you, and you can be part of the change. The current MBS reform has a consumer survey open until 9th November 2015 which aims to help update the MBS to reduce waste and unnecessary treatments. Jump on board now to have your say – you have until 9th November 2015.

This blog was written by Pip Brennan, Executive Director of the Health Consumers’ Council.