1. CURRENT USE OF TECHNOLOGY IN
AUTOMATING PATIENT HARM IDENTIFICATION:
A SURVEY OF PATIENT SAFETY LEADERS
JUNE 10, 2014

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Background
To what extent do safety leaders understand the patterns and
the burden of patient harm in their organizations? What tools
do they need to be able to improve the resolution of their
harm picture? To understand this more clearly, we conducted
a short survey among 570 attendees of the National Patient
Safety Foundation’s annual conference (n=83). Patient safety
professionals from hospitals across the U.S. were asked
about their approach to understanding patient harm in their
organizations.
While it is widely acknowledged1
that addressing factors that
contribute to clinical safety is essential in the modern healthcare
environment, most notably culture2
, there also needs to be an
understanding of what the actual level and pattern of “all-cause”
harm is in an organization. Knowing how patients are harmed
is the first step in preventing that harm from happening again.
Currently we believe most healthcare organizations do not have
a full understanding of how their patients are harmed. We are
confident that having a comprehensive view of harm, delivered
in close to real-time, would be a powerful tool in the hands of
unit-, hospital- and system-level quality leaders for intervention,
learning and improvement.
1
96% of respondents agreed that measuring culture of safety was an important step in their patient safety improvement efforts.
2
Disclosure: Pascal Metrics is a leading culture and employee metrics survey provider. Pascal has surveyed over 1,200 hospitals and over 25,000 clinical units. It
owns the license to the Safety Attitudes Questionnaire (SAQ) but also administers the HSOPS survey and other validated instruments separately or as part of an
all-in-one integrated survey process.
Patient safety leaders agree that,
while the burden and pattern of
patient harm in healthcare are
critical to understand and address,
hospitals lack tools to generate a
comprehensive picture of the harm
in their hospitals.

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Hospitals discuss patient harm
According to our results, healthcare practitioners are regularly
engaging with one another about the impact of patient harm
in their organizations. Only 4% of safety leaders indicated that
patient harm is not commonly discussed (Fig. 1). This response
highlights that hospitals recognize and take seriously the
impact of ongoing patient harm clinically. The majority realizes
the very serious financial impact too3
. Addressing patient harm
issues frequently and systematically helps teams understand
the incidence and etiology of harm, which is the first step in
proactively improving the reliability of the care they deliver to
patients.
QUESTION 1: PATIENT HARM IS COMMONLY DISCUSSED
fig. 1
Hospitals lack reliable harm data
Unfortunately, our survey results suggest that most of those
organizations that regularly discuss the burden of patient harm
may base their conversations on only a fraction of the actual harm
that is occurring. Less than a quarter of respondents indicated
they use technology that shows them their clinically verified harm
patterns in detail (Fig. 2). Subsequent survey questions and our
knowledge of harm surveillance tools on the market suggest the
actual number of respondents using technology like this is even
lower, especially if we consider that the gold-standard is where
patient harm information is provided on every patient and in
close to real-time. Hospital harm discussions are likely informed
by voluntarily reported event data that detects only 1% of all harm
or sample-based, retrospective data using a technique like the
Global Trigger Tool4
.
QUESTION 2: OUR TECHNOLOGIES SHOW US DETAILED
HARM PATTERNS
fig. 2
3
Only 11% of respondents disputed Pascal’s analysis that harm costs over $5m annually in a mid-sized hospital. However, this figure is difficult to know unless
comprehensive harm is being measured on a hospital basis. It is likely to represent the single most significant green-field cost reduction opportunity in healthcare.
4
Classen D.C. et al., Health Affairs 30,No. 4 (2011). In a study of 795 patient records in 3 hospitals, 393 adverse events were detected. IHI’s Global Trigger Tool
detected 90% of the adverse events in the study sample, PSIs detected 9% and only 1% of the events were voluntarily reported. Disclosure: Dr. David Classen is the
CMIO at Pascal Metrics and Co-leader of the Pascal convened National Collaborative to Automate Adverse Event Detection.

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Hospitals would find reliable, real-time
harm information powerful
Moreover, an overwhelming 98% of survey respondents agreed
that it would be valuable to have technology that showed them
patient harm risks and patterns in near real-time (Fig. 3). The
advent of the electronic medical record (EMR) has, in theory,
given hospitals the clinical data that advanced emergent
technologies can use to detect a significant portion of safety
events both reliably and as part of a clinically credible workflow.
QUESTION 3: TECHNOLOGY THAT SHOWS US OUR PATIENT
HARM RISKS AND PATTERNS IN NEAR REAL-TIME WOULD
BE VALUABLE
fig. 3
Releasing the power of harm data
from Hospital EMRs is an exciting new
opportunity
With the contemporaneous view on patient status and clinical
intervention that EMRs make possible, a high-resolution picture
of harm should be attainable. However, survey respondents
are skeptical of their organizations’ ability to use this mass
of rich data to derive actionable insights to improve care in
real-time5
. This approach to ameliorating and avoiding harm
is now possible and increasingly offered by organizations like
Pascal Metrics through population-specific predictive analysis.
However, the first step in using this data in a meaningful way is
to systematically monitor the EMR and Health IT data in real-
time for clinical aberrations using automated triggers to find
harm and potential harm.
5
63% of individuals responded unfavorably when asked about their organization’s ability to analyze EMR data to predict clinical outcomes.

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PSOs play an important supporting role
in measuring harm automatically
On average, safety leaders agreed, given the power of these
systems to discover a great deal of previously undetected harm
- potentially orders of magnitude more than currently reported
– it would be important to protect this information for learning
and improvement purposes in a Patient Safety Organization
(PSO) (Fig. 4). If such a tool were to be provided as part of the
EMR it would not be secure enough to protect the hospital from
potential litigation; a separation is required to protect the data.
This is certainly the emerging view of the industry as PSOs find
genuine significance as part of a real-time learning system6
.
QUESTION 4: IF WE HAD ACTIONABLE HARM DATA IT WOULD
BE IMPORTANT TO SAFEGUARD IT IN A PSO
fig. 4
Risk Trigger® Monitoring
Pascal Metrics has brought all this powerful functionality
together. Within its PSO, Pascal has developed a tool called Risk
Trigger® Monitoring (RTM), a powerful, clinical software service
that automates the detection of comprehensive harm across the
hospital (Fig. 5). RTM monitors EMR and other Health IT data
in real-time with advanced trigger methodologies. The trigger
events detected are presented within an intelligent workflow
to a hospital safety “control tower” where clinical observers/
investigators can document harm events effectively for learning
and reporting purposes. Moreover, they can report important
clinical findings about patients back to front-line providers
when intervention is required. In early client partners, even
severe harm is being documented before clinical teams report
through more traditional methods.
THE POWER OF RISK TRIGGER MONITORING
fig. 5
6
Pascal Metrics is a federally certified Patient Safety Organization and the Risk Trigger® Monitoring software service application is embedded within this construct
to make comprehensive harm data safely available for learning and improvement.

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Summary
Patient harm is a crucial dataset to have clarity on for healthcare organizations looking to
generate consistently high-quality, highly reliable care. Until this information is routinely
available, the burden of patient harm will be ineffectively addressed and will continue
to drive increases in costs for healthcare organizations as we enter a new era focused on
value-based pricing. Infrequent anecdotes or retrospective, sample-based patient harm data
are likely to command less attention in the minds of hospital leaders, who already have
dependable financial and process-related metrics from other areas to analyze for intervention
opportunities.
Encouragingly, over 77% of respondents indicated that they planned to learn more about
automating the measurement of patient harm. Using RTM and Pascal Metrics’ clinically
validated workflow, hospital leaders are afforded a transformative opportunity to reliably
understand patterns of harm at every level of their organization and leverage this knowledge
to increase both the quality of care they deliver and the cost at which it’s delivered.