March 14 through March 20, 2021 marks Patient Safety Awareness Week, which was created by the Institute for Healthcare Improvement (IHI) to encourage discussion and promote awareness of safety issues within health care. This year, Brigham and Women’s Faulkner Hospital’s Departments of Patients Safety and Risk Management are highlighting efforts to develop equity frameworks within our safety event review process to identify and address potential bias, discrimination or disparities in care delivery.
The IHI website notes that, “Preventing harm in health care settings is a public health concern. Everyone interacts with the health care system at some point in life. And everyone has a role to play in advancing safe health care.” At BWFH all staff members have the opportunity to participate in creating a safe environment for patients and staff by using the RL Solutions safety reporting system which is often called simply “RL” by hospital staff. With the help of our IS department, the Patient Safety Department created an interface between the Epic record and the RL platform to allow demographic information to get pulled into the safety reports. Race, ethnicity and language (REaL) data from Epic now populates into the safety reporting system. This interface allows Risk and Patient Safety to develop equity informed reviews of safety events. The Workplace Safety and Patient Safety Committees have used this data to analyze patterns regarding patient violence episodes, hospital acquired pressure injuries and patient flagging requests. Our goal is to learn more about system issues around patient care in order to remove or address bias or gaps in equitable care.
Similarly, BWFH’s Collaborative Case Review (CCR) process follows an equity informed high reliability framework. Christi Barney, RN, MSN, Executive Director of Patient Safety, Quality and Risk notes, “We use demographic information at the start of a CCR to help the team think about the patient as a whole person – age, gender identity, race, language, ethnicity – in order to ask critical questions about our systems of care. This allows us to see where an issue, such as communication due to language, plays a part in the risk. We can then celebrate where the system is working well – the team’s easy access to a translator during a code as an example – or work on the risk points and barriers.”
As part of these efforts, there is now a drop-down field in all safety reports that asks the reporter: “Is there a concern for bias or discrimination in this case?” When a reporter checks “yes” then the report is automatically routed for review to senior leadership, human resources and to the Senior Director of Public Safety and Support Services, Terrance Lassiter who chairs BWFH’s Diversity, Equity and Inclusion (DE&I) Committee. This allows the hospital to rapidly respond to equity concerns from front line reporters.
Allyson Hammerstedt, Senior Risk Manager, a member of the DEI and Equity Committees leads CCRs and reviews safety events through the lens of equity. “Retrospective reviews allow us opportunity to address the social determinates of health as legitimate and routine aspects of health care. We work to support care teams in facilitating transparent discussions as they continue to tailor and support patient centered care. This is a top to bottom, side to side operation that spans the institution.”
There are several opportunities to participate in Patient Safety Awareness Week. The IHI is hosting an expert panel on Workplace Violence: Protecting Health Care Workers on Tuesday, March 16 from 1 – 2 pm. And Brigham and Women’s Hospital hosts the Thorndike Quality and Safety Grand Rounds on Thursday, March 18 from 12 noon – 1 pm via Zoom: https://partners.zoom.us/j/93103636220.
“Everyone can join us by entering a safety report,” says Barney. “Safety reporting is the best way the hospital hears about risk points from the front-line staff and our equity data fields support our goal to provide inclusive and equitable care for all.”
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