Our thanks to Pravina Khant, RN, MSN, who shares a detailed review of the readmission and adverse event reporting system Hartford HealthCare Digestive Health Institute has implemented across its system.
Background and Aims
Hartford HealthCare Digestive Health Institute, including Hartford Hospital Endoscopy Center, MidState Medical Center, The Hospital of Central Connecticut - New Britain, Backus Hospital, Charlotte Hungerford Hospital, Windham Hospital, St. Vincent’s Medical Center and The Hospital of Central Connecticut - Bradley Memorial Endoscopy Center, determined the need for a standardized system to track all hospital readmissions within two weeks of an endoscopy procedure. This system would include any adverse events that may have occurred during or after the procedure. A project was initiated to create a real-time notification system that could track hospital readmissions and adverse events within 14 days of all outpatient endoscopy procedures.
On November 1, 2023, we successfully implemented a system allowing us to receive notifications for readmissions within two weeks of an endoscopy procedure report. This project was crucial for all the Hartford Hospital Endoscopy sites as it aimed to improve and standardize the reporting of adverse events related to GI procedures. The system serves a critical need in helping to enhance patient safety.
Real-time notifications are configured to be activated in the EPIC in-basket when a patient is readmitted within two weeks of the endoscopy procedure, whether they visit the ER or are admitted directly from the GI procedure. We also receive notifications even if the patient goes to a hospital outside this system as long as the hospital uses EPIC.
We have created a survey template in RedCap (Research Electronic Data Capture) to document all readmissions, regardless of whether a readmission is related to the endoscopy procedure. This is in addition to the real-time notification system we already have in place. The RedCap intake form is divided into four sections:
- Patient Information
- Classification/Complications/Casual Factors/Conclusion
- Determination of Cause
- Case Status
Under classification, we have started to use AGREE Classifications.
Process
- We are implementing one site at a time.
- As the GI quality RN at Digestive Health Institute, I receive notifications in real time and forward them to the site manager and GI chief. The manager is responsible for discussing the information with the GI chief and entering it into RedCap. If the readmission is unrelated to the procedure, then no further questions in the survey need to be answered.
- After the site manager completes the survey, I, as the GI quality RN representative, receive an email notification informing me about the completion of the survey for a specific patient's readmission or adverse event. If the readmission is considered an adverse event, it will be reviewed and discussed in the GI division meeting, and a conclusion will be made based on the following:
1. Was this event:
- Nonpreventable
- Potentially preventable
- Preventable
- Unable to determine
- Other
2. Action item:
- Education opportunity
- Equipment-related
- Policy review
- Procedure review
- Workflow opportunity
- No further action needed
- Other
3. Referral to:
- Risk management
- Root cause analysis team
- GI division chief/peer review
- Anesthesia
- Other department of surgery division
- Department of Surgery Quality Committee
- No further action
- Other
On December 1, 2023, Hartford HealthCare implemented a new notification system for post-ERCP (Endoscopic Retrograde Cholangiopancreatography) report cases. The EPIC system sends alerts if a patient's lipase levels are three times higher than the normal limit within six to 24 hours after the ERCP procedure. The report includes various columns such as the lipase levels before the ERCP procedure and whether the patient received any of the following treatments:
- Rectal indomethacin
- Rectal ketoprofen
- Rectal naproxen
- Rectal diclofenac
The GI chief reviews each report before it is entered into RedCap to track post-ERCP pancreatitis.
Action
I am excited to announce that we have successfully implemented an extensive project to improve patient quality and safety. As part of our efforts, we plan to establish an M&M (morbidity and mortality) in the GI division meeting to discuss all adverse gastrointestinal events across all Hartford HealthCare sites. The primary objective of this meeting is to identify areas of improvement and achieve our goals while enhancing patient safety. Furthermore, we are currently working on setting up a system to receive notifications for adverse events related to inpatient status, which will further improve our ability to provide the best possible care and ensure patient safety.