kc_articles_pv_kriegel_world

Duration: 3:43

This podcast is an episode of Patient Safety Updates. You can find other episodes and subscribe using the links to the left.

Whether it’s devising a “near miss” reporting system, learning lessons from a malpractice case, or using information technology to coordinate with specialists, Gila Kriegel, MD been attacking medical error in primary care far longer than most. Now that ambulatory care is the vanguard of patient safety, her insights are more valuable than ever. Dr. Kriegel shares her motivation and the excitement of getting attention and funding for her efforts.

Transcript

I love quality improvement work because I feel that the work that I’m doing extends to other patients in our practice, but also to other patients in the whole hospital, the BI system, and through the work with CRICO to other Harvard hospitals. So that’s very motivating because you can just multiply your efforts and see them making a difference.

When things go wrong, the doctor will say to themselves, what did I do wrong? And what we find so often is that it’s not that the individual physician or provider did something wrong, it’s that the systems didn’t support them sufficiently and yes, occasionally, not infrequently, it’s that there was a cognitive error made and we are thinking about that too. But so often there are systems issues that we can make a change and prevent something like that from happening again. We see it over and over and over again.

A good example of a project: when a patient has their spleen removed, they are at increased risk for infection, and there are a series of recommendations of what you do for a patent who has had their spleen removed so they are asplenic. They have no spleen, in terms of immunizations, giving them antibiotics in the event of an infection. So we were able, with the help of the IT group, to pull a list of all of our patients—or many of our patients anyway—who fit into that category. We had some help and looked into those charts, and we found that only 14 percent of our patients had had all of the recommended interventions.

So that was a project that flowed from a case and then we were able through sort of a PDSA cycle of, we tried one thing, it didn’t work so well, we tried something else and it worked better. Ultimately, we got up to over 85 percent of our patients, almost close to 90 percent, having all the recommended interventions for that group of high-risk patients. That’s an example of one thing that we did. I could give you a lot of others, big and small projects that, when we look into one case, we say okay, if we could fix this, this might not happen again and now we have impacted on all these patients.

As the systems become more complicated, you need to be able to step back and look at when things go wrong, how can you change those systems to make sure that your patients are getting the best quality of care and that there aren’t things in the system that are conspiring against that.

One of the ways that we at least are beginning to try to do that is through population management, which requires better IT capabilities than we have in our institution right now but we’re getting there. There is a lot of effort, and because some of the insurance companies and ACO are sort of imposing this on us, there’s enough money behind it that that’s sort of driving us to get to those solutions faster than we ever have before.

Subscribe to Safety Net
Sign up and keep up.

Safety Net

These episodes can help you promote patient safety in your organization.
See all episodes

About the Series

We’ve got you.

Our Safety Net podcast features clinical and patient safety leaders from Harvard and around the world, bringing you the knowledge you need for safer patient care.

Episodes

Recent episodes from the Safety Net series.
    1x1_auto_0018

    New Guidance on Preventing Lost Medical Specimens

    Podcast
    It is estimated that thousands of medical specimens are lost each month. The impact on the diagnostic process when a specimen is lost is of particular concern. In early 2022, a patient safety document was published by the Academic Medical Center Patient Safety Organization, or AMC PSO, to describe ways to prevent harm to patients when specimens are lost. Safety Net interviews two participants with some advice for QI.
    1x1_auto_0017

    Making Sure Patients Don’t Catch Fire During Surgery

    Podcast
    Hundreds of patients are harmed in OR fires every year. Experts in patient safety want hospitals and providers to focus more on lowering the potential for fire during surgery.
    clinicians next to a medical simulation manikin

    Simulation’s Evolving Place in Health Care

    Podcast
    The use of simulation in health care has grown worldwide. This year and through 2028, industry business analysts expect double digit growth in a $2 billion market for simulation services, software, and anatomical models. We interview pioneers and leading edge practitioners of the art.
Subscribe to Safety Net
Sign up and keep up.
X
Cookies help us improve your website experience.
By using our website, you agree to our use of cookies.
Confirm