Money Health

Managing risk: safe patients, secure budget

May 26, 2010
by Olga Deshchenko, DOTmed News Reporter
This report originally appeared in the April 2010 issue of DOTmed Business News

The delivery goes smoothly and the mother gives birth to a healthy girl. But the baby leaves the hospital motherless. To the shock of the obstetrics team, she dies of postpartum hemorrhage, a leading cause of maternal mortality.

"There's often a miscommunication of how much blood was lost during the procedure and how much blood was lost while on the floor," says Amelia Newbury, chief operations officer of the eLearning department for Advanced Practice Strategies (APS). "That lack of communication and coordination can sneak up on you."

Recent studies estimate that 70 to 95 percent of deaths from postpartum hemorrhage are preventable. The course on the subject designed by APS aims to help medical professionals recognize common errors, reduce patient risk and avoid potential liability.

APS is a leader in the arena of patient risk management. Its eLearning department generates educational courseware based on real clinical experience. The company's strategic partners include the Risk Management Foundation of the Harvard Medical Institutions, the Hospital Corporation of America (HCA) and contacts in several academic medical centers.

"We reach out to that rich base of clinically connected subject matter experts and we ask them what their opinion is on why these errors are occurring," says Newbury. "We take a look at what themes are popping up for us and we then solicit these experts to help us understand solutions."

Commercial insurance carriers, captives (self-insured entities) and smaller, individual hospitals make up the majority of the company's clientele. APS partners with its customers to create custom-branded web sites for specific safety initiatives. Users are then able to log-on and complete the courses tailored to their needs. APS reports back on the compliance of the users, who may then receive incentives or certain privileges from their employers. In the case of a carrier, the reward is a reduction in liability premiums.

"The carriers are directly influencing the care that's rendered by their insured, thus reducing the risk to insure that individual because they're better educated as a result," says John Harrington, APS founder and chief mission officer.

HCA, the country's largest private health care delivery system, collaborated with APS on an extensive safety initiative. The company was responsible for delivering standardized online education courses to thousands of medical professionals.

"HCA was addressing their chief risk area, which is perinatal safety. Their obstetrical risk was crippling the system," says Harrington. "We partnered directly with HCA and their thought leaders to develop our advanced electronic fetal monitoring course."

Throughout 120 hospitals nationwide, 4,800 nurses and 2,500 physicians completed APS coursework. As a result of the initiative, HCA saw a 48 percent reduction in claims.

"We have a loss of pre-initiative in excess of $200 million to the nadir of 2006 with a cost of less than $12 million," says Harrington. "Now there's still work to be done, but that's a significant impact on perinatal claims, what they attribute to narrowly $80 million on an annual basis in savings."

APS also played a role in an extensive perinatal safety initiative launched by the Risk Management Foundation of the Harvard Medical Institutions. In this case, adverse outcomes were used as a measure to evaluate the success of the initiative in real time.

"They had a 62 percent drop in claims, again, representing significant organizations," says Harrington.

At first, the company mostly focused on providing medical illustrations for defense counsel in cases of medical malpractice claims. APS expanded its business after not only gaining experience in understanding where medical errors originate, but also recognizing how they can be prevented.

"We learned early on that if we could educate doctors to think more proactively in their management, to improve the team dynamic, the coordination and communication, we could have an impact on adverse events right from the beginning," says Harrington. "If an organization reduces its adverse events, its claims will fall off as a result."

Perinatal claims are the top liability concern for hospitals nationwide, closely trailed by surgical errors. APS recently partnered with the Association of periOperative Registered Nurses (AORN) to create courseware for the OR Safety Series, designed to cultivate the expertise of nurses in surgical settings.

"In our courses, we are encouraging all caregivers to recognize that they have a voice," says Harrington. "Not only do they have voice, but they have a responsibility to speak up as a part of the care team. And that is what our mission is all about: empowering caregivers to work together as a cohesive team to improve outcomes for their patients."