Speaking during the three-day Patient Safety Virtual Edition, members of the global healthcare community from Singapore to the Middle East addressed the impact of the COVID-19 pandemic on patient safety, along with any new strategies deployed.
They revealed changes made in areas that included workflow enhancements, training, and technology in the form of new platforms.
How caregivers are the heroes of the pandemic
Dr Samer Ellahham, Regional Chair, Middle East Patient Safety Movement Foundation; Director, Accreditation; Cardiology Consultant, Cleveland Clinic Care Giver, Cleveland Clinic Abu Dhabi was keen to stress that, at the end of it all, to err is human.
Healthcare, he conceded, is advanced but not reliable. When a medical error emerges it affects the entire team, medical organisation/hospital and community, rather than just patient and doctor alone.
With the COVID-19 pandemic, new issues emerged. It challenged the entire healthcare system, including quality and safety, and undermined progress in ways that included:
- Staff reductions;
- ongoing distraction;
- lack of coordinated messaging between leaders;
- staff redeployment to new roles responsibilities and locations;
- new treatments for a new diseases resulting in new errors.
Measures introduced in response included telemedicine, PPE strategies, approaches to protecting healthcare worker safety, wellness resources, and communication with patients and healthcare workers.
Above all, he acknowledged the importance of frontline workers. “The healthcare community remains dedicated, resilient, and adaptable.” Caregivers are the true heroes, he added, with each and every one touching the lives of patients. “No offence to musicians or sportspeople. No offence to Hollywood.”
He remains optimistic that “we can continue to provide our patients with effective and compassionate care without sacrificing the health and safety of our teams, colleagues and families.”
The speaker noneltheless called for new ways of thinking beyond what he called "linear reductionism”, and underlined the need to be open and creative. Quality is a journey not a destination, he concluded.
AI enhances patient safety
In a separate session during the Patient Safety virtual event, Dr Samer Ellahham elaborated on the impact of AI on patient safety, in that it helps in reducing the burden of healthcare professionals by managing patient flow. It supports an early response to the pandemic by enabling efficient patient monitoring, screening and decision-making for the prevention of large-scale community spread.
Its practicable algorithms provide updated information to all individuals about positive cases in their vicinity as well as probable sites of infection and virux influx around. Clear description of cases helps in local awareness, health education and information allowing individuals to take necessary precautionary methods.
He added that well-trained AI models are also useful in providing insights into the disease and drug treatment, which are not yet understood by practitioners. A useful discovery made with the help of deep learning algorithms is that patients may continue to spread the disease even after their efficient recovery because diagnostic tests were found to be positive 5-13 days after treatment.
The use of AI overall helps in enhancing patient safety due to early identification of complications and their logical management.
He cautioned that a limitation includes the lack of clinical trials demonstrating the safety of the use of AI in COVID-19 positive cases. This limits its use in diagnostic and treatment-related roles.
Also, in vulnerable cases/patients with comorbid conditions, there is a lack of consensus-based guidelines devised by experts, which ascertains that sole dependence on AI in these cases may cause harm to the patient.
New data dashboard improves the patient experience
Claire Jones-Manning, Decontamination Lead of University Hospitals of Leicester NHS Trust, revealed challenges during and post-COVID from an operating room perspective.
She told how the pandemic put on a pause on activities, enabling Leicester healthcare professionals to focus on how they conducted these and make changes.
The teamwork they had internally was "outstanding", from clinicians to management to nurses and matrons, and communication with outside bodies was effective - there was support providing equipment during the darkest days. In addition there were no external pressures - companies were not trying to sell new products for example.
The pause also allowed an opportunity to review equipment to see whether it was fit for purpose and what was needed. Staff were additionally reployed to different roles, which was a real positive reflecting the positivity of doctors and nurses in those areas.
IT was fixed, allowing the team to use solutions in ways not possible previously. An example of this was the development of a Theatre Productivity Dashboard (Qliksense) to view key metrics of intensive care, theatre, anaesthetics, pain and sleep, and other data such as turnaround time.
The dashboard also informs management where the team can improve in on-day non-clinical cancellations, for example, which can be an "awful patient experience".
However, there were challenges that included decision-making, insufficient equipment and storage space for equipment, a rapidly changing situation, and staff exhaustion.
Mindspace platform launched to provide emotional support to caregivers
Dr Allison Herbert, Staff Physician - Department of Preventive Medicine and Executive Health, Medical Subspecialties Institute, Cleveland Clinic Abu Dhabi
Dr Herbert revealed five areas of improvement with overlapping themes under Clinical Risk Assessment, that included workflow, specimen handling, caregiver safety, caregiver training and environmental.
In workflow terms the clinical space was divided so that symptomatic and asymptomatic sides were developed. For example in the case of the former, caregivers were swabbed by the nurse, who then determined whether a phone consultation with the physician was appropriate or a an in-person home visit instead.
Other workflow changes included introducing dividers and signage, eliminating outside seating areas, separating waiting areas, establishing that visits were appointment only (through online scheduling), defining traffic control through health unit coordinators, and mandating universal COVID-19 precautions such as social distancing and hand-washing.
Specimen handling measures were introduced that included communication of results, assigning a "clean" and "dirty" nurse to every room to handle samples, and defining a workflow on where samples were handed off.
To safeguard caregiver safety, changes were brought in such as moving non-clinical staff out of symptomatic areas, assigning "clean" and "dirty" tasks to separate nurses, ensuring that nearly all doctor visits became telephonic, and changing the flow of suspected caregivers to create "clean" and "dirty" areas/corridors.
Many training actions were also identified for caregivers, for instance training for donning and doffing, and standardised nurse training for swabbing.
There were environmental measures - for example placing air purifiers and exchangers in swabbing rooms, and creating an area for donning and doffing PPE outside the swabbing area.
Caregiver anxiety was also addressed to address challenges such as working from home (demotivation and isolation), working in different hospital environments and adapting to constantly changing rules/guidelines. Solutions included the launch of a mindspace platform, online workout sesions and weekly leadership virtual updates.
Mindspace was a platform launched as a safe environment to share experiences. Facilitated by a professional mindspace coach, there are 1 on 1 coaching conversations, curated content, tips for leaders on how to best navigate with their teams, and tailored team coaching initatives.
Holistic approach works best
Dr Wai Khuan Ng, Principal Consultant, Infection Prevention & Control, Joint Commission International (JCI), based in Singapore, revealed the six areas most affected by the pandemic, as shown by JCI field team feedback. She was speaking during the session COVID-19 pandemic - What have we learned?
The areas named were utilities, staffing, safety and securiy, communications, patient management, and resources and assets. Patient management and resources and assets were seen as the most challenging areas, while utilities and staffing were least challenging.
She shared an Emergency Management framework, explaining that it helps develop practical and actionable operations and policies. The consultant also advocated a "holistic approach" that included working with the community, working with other healthcare organisations, strengthening relationships with suppliers, and preparing for evacuations.