BIDMC aims to improve family engagement and reduce overall risk of harm in ICU

Beth Israel Deaconess Medical Center is embarking on a new phase of its mission to eliminate preventable harm, using information technology and system science together with patient and family engagement to head off harm before it happens.

BIDMC will use this opportunity to define the "burden of harm" in the ICU, including the loss of dignity and respect, as it moves to a systems approach to eliminating preventable harm.

BIDMC will leverage its nationally recognized position as an innovator in information technology and leader in patient/family engagement with the goal of providing timelier, informative, and actionable information to intensive care patients, families and providers. The goal is to develop tools to support interventions designed to eliminate preventable harm in the ICU.

Backed by a $5.3 million granted from the Gordon and Betty Moore Foundation of California, the effort will result in a family of innovative IT applications designed not only to improve patient and family engagement but also to reduce the overall risk of harm in the intensive care unit.

As part of this effort, a team of BIDMC clinicians and MIT system scientists will develop a model for measuring and managing the leading indicators of risk for harm in the ICU, including a dashboard system to raise clinicians' awareness of conditions that may threaten patient safety.

This work represents an innovative approach to patient safety that seeks to improve underlying system performance in the ICU by identifying and acting on risk conditions that lead to harm.

"Beth Israel Deaconess Medical Center has a long and distinguished history in patient and family engagement, starting with the nation's first Patient Bill of Rights in 1972 to its commitment in 2008 to eliminate preventable harms in its medical center," said Steve McCormick, President of the Gordon and Betty Moore Foundation.

"This commitment, coupled with the center's nationally-recognized innovations in technology, aligns with our Patient Care Program and the vision of our founders, Gordon and Betty Moore."

BIDMC was the first hospital in the country to win federal meaningful use attestation. Other national achievements include the 2010 receipt of the Society of Critical Care Medicine Family Centered Care Award; 2012 recognition by Information Week for technology innovation; and the 2013 AHA-McKesson Quest for Quality Award for leadership in quality improvement and safety.

"We are honored to be part of the Moore Foundation's ICU Consortium which is on the same path that BIDMC stepped onto in 2008, which is to eliminate preventable harm" said Kevin Tabb, MD, BIDMC's President and CEO.

During the 30-month grant, BIDMC will work with its ICU providers to build upon and improve current practice with IT tools that provide nurses and physicians with the right information for the decisions immediately at hand for each patient.

"While checklists applied to critical care processes may be spectacularly effective, when scaled to try to prevent all harms, they may actually cause harm by overwhelming providers," said Kenneth Sands, MD, BIDMC's Senior Vice President of Health Care Quality and Chief Quality Officer and one of two principal investigators on the project.

Even more crucial to the provision of the appropriate care for each patient is a lack of systematic engagement of patients and families in understanding and identifying risks in ICUs. That failure may result in loss of dignity and respect, particularly when clinicians are not aware of the wishes of patients and their families in terms of how they would like to be involved and how much or how little effort is desired.

"Critical care scorecards almost never include quantitative measures of patient's perceptions of dignity and respect in the ICU," said Daniel Talmor, MD, Vice Chair of the Department of Anesthesia, Critical Care and Pain Medicine and the other principal investigator on the grant.

With this in mind, two key components of the project are to create checklists that will provide patient-specific information to clinicians, allowing them to make the right preventative-care decisions at the right time.

The information would be available to doctors, nurses and other care providers in real-time through a provider-facing interface. A separate interface that relies on easy-to-understand language that facilitates communication between patients and families and providers in the ICU will also be developed.

"These innovations would enable open, real-time discussions between care providers, patients and family members in a critical care environment where, due to its complexity, this type of information has traditionally been available only to providers," added Talmor.

Finally, the project aims to extend this level of engagement beyond a city-based academic medical center to community hospitals that often face the same challenges. With that reality in mind, select innovations will be piloted at Beth Israel Deaconess Hospital-Milton and Beth Israel Deaconess Hospital-Plymouth.

"Until there are clear models for spreading safety innovations from large hospitals into community hospitals the national impact of patient safety will continue to be minimal," said Sands.

With this grant, BIDMC will join Johns Hopkins Medicine, the University of California San Francisco and Brigham & Women's Hospital as part of the ICU Consortium to examine how to redesign the health care system in order to eradicate these pervasive problems.