The Safety Risk Assessment: SRA Components: New in 2014 Falls 9/5/2014 HEALTHCARE REFORM AND DESIGN
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1 The Safety Risk Assessment: A new Guidelines requirement Ellen Taylor, AIA, MBA, EDAC Director of Research, The Center for Health Design HGRC Member 2014, 2018 * The views and opinions expressed in this presentation are the opinions of the speakers and not the official position of the FGI or HGRC AHCA, September 2014, Orlando, FL 1 SRA Components: New in 2014 Falls Patient Handling (existing) Security Safety Risk Assessment Infection Control (existing) Psychiatric Injury (existing) Medication Safety Immobility AHCA, September 2014, Orlando, FL 2 HEALTHCARE REFORM AND DESIGN AHCA, September 2014, Orlando, FL 3 1
2 Spotlight on Safety Institute of Medicine published reports: 44 98K Americans die each year because of medical errors Founded in 1999, the National Quality Forum (NQF) is an independent nonprofit organization that refines and endorses standards and measures of healthcare quality through a national consensus based approach. AHCA, September 2014, Orlando, FL 4 TJC ( 04 2Q 12) RCA Sentinel Events Sentinel Events Phy Env RCA (outcome: death/ events (may be permanent loss of function) multiple) Total (N): (2Q) (top 5 bordered) % Phy env RCA (top 5 highlighted) 1. Suicide (Psych Injury) % 2. Falls % 3. foreign object % 4. delay trtmnt % 5. med equip % 6. Criminal events (Security) % 7. wrong pt/site/proc % 8. post op complication % 9. Medication errors % 10. Elopement (Security) % Reporting to The Joint Commission is voluntary and represents only a small proportion of actual events; therefore, these data are not an epidemiologic data set AHCA, September 2014, Orlando, FL 5 NQF Never Events /Serious Reportable Events Classen, et al., 2011 AHCA, September 2014, Orlando, FL 6 2
3 A Fundamental shift: Volume to Quality AHCA, September 2014, Orlando, FL 7 Reimbursement Linked to Quality 2005 Deficit Reduction Act Section 5001(c) Starting in FY 09, hospitals are no longer paid at the higher rate for the increased cost of care that results when a patient is harmed, including care for: Falls and trauma Catheter associated urinary tract infections Vascular catheter associated infections Surgical site infections Inpatient Prospective Payment System Reimbursement AHCA, September 2014, Orlando, now FLtied to performance Patient Protection and Affordable Care Act Hospital Value Based Purchasing Program Beginning FY 15 Patient safety indicators will further tie HACs to reimbursement Partnership for Patients Program 10 targets Adverse Drug Event (medication errors) Catheter Associated Urinary Tract Infections CLABSI Injuries from Falls and Immobility Surgical Site Infections Ventilator Associated Pneumonia Each year measures will be added, many of which will target hospital acquired AHCA, September conditions 2014, Orlando, FLother patient safety indicators 9 3
4 The Built Environment & Adverse Events Conceptual model based on Reason s model showing the role of the environment as a latent condition or barrier to adverse events in healthcare settings. Source: Joseph (2007) AHCA, September 2014, Orlando, FL 10 Some Implications Falls Operational costs for fallers with serious injury $13,316 more than controls LOS 6.3 days longer than non fallers Patient Handling Mean cost of devices: $53,571 vs. mean savings in workers compensation costs associated with patienttransfer injuries: $71,822/yr Mean payback period was 15 months (range = 5 to 31 months) Falls: Wong, Recktenwald, et al. 2011; PH: Garg and Kapellusch, 2012 AHCA, September 2014, Orlando, FL 11 Some Implications Early Ambulation/Immobility Patients who increased their walking by at least 600 steps from the first to second 24 hour day were discharged approximately 2 days earlier than those who did not HAIs (infections due to medical care) A patient with one of these infections cost nearly $43,000 more to treat than non infected patients ALOS 19.2 days longer than patients without infections Early Ambulation: Fisher, Kuo, et al. 2010; HAIs: Lucado, Paez, et al AHCA, September 2014, Orlando, FL 12 4
5 Phases of a Facility Design project Strategic Planning Facility Master Planning Process/Operational Planning Functional Programming Design (Schematic and Development) Construction Documentation Construction Commissioning/Punch List Occupancy $ $$$ AHCA, September 2014, Orlando, FL 13 THE GUIDELINES AHCA, September 2014, Orlando, FL 14 *1.2 3 Safety Risk Assessment (SRA) SRA Requirement All health care facility projects shall be designed and constructed to facilitate the safe delivery of care To support this goal, an interdisciplinary team shall develop a safety risk assessment A1.2 3 Safety risk assessment (SRA). The SRA is a multidisciplinary, documented assessment process intended to proactively identify hazards and risks and mitigate underlying conditions of the built environment that can contribute to adverse safety events. These adverse events include infections, falls, medication errors, immobility related outcomes, security breaches, and musculoskeletal or other injuries. The SRA process includes evaluation of the population at risk and the nature and scope of the project; it also takes into account the models of care, operational plans, sustainable design elements, and performance improvement initiatives of the health care organization. The SRA proposes built environment solutions to mitigate potential risks and hazards. AHCA, September 2014, Orlando, FL 15 5
6 AHCA, September 2014, Orlando, FL 16 THE PURPOSE AHCA, September 2014, Orlando, FL 17 AHCA, September 2014, Orlando, FL 18 6
7 SRA Process (Guidelines Framework) Based on location, identify hazards: Physical obstacles and underlying conditions that may directly or indirectly contribute to harm Location Data Identify vulnerability, based on past data (recognizing past performance does not guarantee future results) Prioritize the degree of potential harm from the hazards identified Harm Mitigation Identify features that contribute to risk and strategies to reduce mitigate or eliminate risks (e.g. visibility, light, noise) AHCA, September 2014, Orlando, FL 19 One Option AHCA, September 2014, Orlando, FL 20 The Center for Health Design: AHRQ* funded project Develop recommendations for the structure and process for apsra(patient Safety Risk Assessment) to inform guidelines language Create a summary of multidisciplinary patient safety practices and research Develop recommendations regarding specific safety related tools that could be used at different points in the design process *Agency for Healthcare Research and Quality AHCA, September 2014, Orlando, FL 21 7
8 The Center for Health Design: AHRQ Grant Goals Develop an SRA toolkit that can be used to conduct a proactive safety risk assessment during the healthcare facility design process Further develop a Safe Design Roadmap for healthcare CEOs and integrate with the SRA toolkit Create an education platform to advance successful SRA activities. AHCA, September 2014, Orlando, FL 22 Safety Risk Assessment Toolkit timeline Safe Design Roadmap & SRA Tool Development SRA Tool Validation & Integration SRA Toolkit Dissemination & Evaluations Seminar at MedStar Institute for Innovation (June) Seminar at Kaiser Permanente s Garfield Innovation Center (May) Results and SRA Training at ASHE PDC Summit AHCA, September 2014, Orlando, FL 23 Add interface screenshots AHCA, September 2014, Orlando, FL 24 8
9 AHCA, September 2014, Orlando, FL 25 AHCA, September 2014, Orlando, FL 26 AHCA, September 2014, Orlando, FL 27 9
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