Steven Porter 00:07
I am a practicing obstetrician gynecologist, I maintain an active clinical practice, I see patients a couple of days a week, both in the hospital and the office. And the need for risk LD, the really was was spun out of about 10 years of quality and patient safety work at a large health system in Northeast Ohio, where I'm affiliated. And essentially, the team had been looking for many years at drivers of cases that have come up for quality assurance review, if ever there had been an adverse outcome for either a mom or a baby. And, and the team realized that almost any of these cases, almost all of these cases could be traced back to one of two sources of error, the first being what we call a lack of situational awareness, which essentially just means that the clinical team wasn't aware of a problem until it was too late.
The second problem that was seen more community hospitals, as opposed to academic medical centers was patients not being managed optimally, patients not be managed appropriately, even after a high risk condition had been flagged. And so we stepped back and we said, Okay, well, at risk of oversimplifying the problem. If if, if is this, this can be traced back to either not knowing about the problem are not managing it effectively. Wouldn't it be great if we had a technology that we could deploy on our labor and delivery units that would help us identify and hopefully mitigate these sources of error, the biggest problem with most EMRs is what we call disaggregation. of information. You have information stored in multiple different parts of the chart. And so you have this hunt and peck model where if you are trying to access the patient's lab results, you need to click over here. And if you want her recent set of vital signs, you click here. But if you want to look at the 12 hour trend, it's in a different part entirely. Yeah. And when you are doing that sort of hunting and pecking, the information inevitably can get missed. What we are doing is mining for all of that critical information, we're consolidating it and bringing it together on a single user interface. And we're also bringing together information on both mom and baby onto that user interface.
So risk LD is a patient safety solution. It is a software platform that fully integrates with the inpatient electronic medical record. And it provides a combination of early warning and clinical decision support at the point of care on labor and delivery and postpartum. So the whole mission of the software, the mission of our company, is to improve perinatal outcomes and then to reduce risk for laboring moms and their babies.
Mark Greenawald 02:58
One of the things that I've certainly learned when it comes to physician emotional health, mental health, physician health in general is that it's something we don't really talk about a whole lot, that it's a little bit taboo that we are the caregivers, we are not the cared for. And I think that that is both we're selected out for that to a certain degree. And then we're also socialized and trained to both believe that and act that way,
I come from a military background. So in the military, every branch of the service has something like this, you know, whether it be shipmates for the Navy, we hear a lot about wingman in the Air Force. It's those kinds of thing battle buddies in the army, that there's there are places that say you just don't do this by yourself. And certainly healthcare should be included in that because it's danger everywhere that you turn or potential danger everywhere you turn, though
what we know from the data, of course, is that physicians do not in general reach out for emotional support and emotional help, even when they need it. And often they don't recognize that they need it. As we know, over the last decade, more and more data have come out about the burnout epidemic and all of what I consider the distress that healthcare and the provision of health care causes. What we found, though, is that as that data came out that the initial the initial research data set 40 some percent of physicians across all specialties, on average were in the state of high burnout, which means that they were emotionally exhausted, they had nothing left in their tank. They were starting to experience cynicism or depersonalization. They basically started looking at those people they cared for as objects, and often objects that were impediments in terms of getting them somewhere outside of gotta get out of here. And then finally they they were experiencing a sense of meaninglessness that the work that we do the work that's so important that people were called for have given up a lot of time and education for didn't, wasn't making a difference.
And he started to believe that and so, so that that that syndrome that we call burnout is In any of those gets gets high enough that it starts to impact physicians in terms of their performance. And again, the the in many ways the call to action was pretty tepid at best. And there were some good attempts nationally to begin to at least bring attention to this. What I have found in terms of my work is that as we started looking at this not as a physician problem, but rather a quality and safety issue, all of a sudden health care systems started looking at this differently.
So if if you go to health care leaders often and say, you know, the physicians are kind of they're hurting right now. The answer doesn't come across this way. But it often sounds like for doctors, you know, we feel very sorry for them. But you know, they get paid a lot. And they're there, they get a lot of privilege and get back to work. And that's what I think a lot of physicians experience such that they stop asking for help, even if they have had the courage to begin to ask for help. So what I thought was, what would it look like to create something that is proactive, rather than reactive, and is supportive, independent of an event? So a tragedy doesn't have to happen before somebody reaches out and says, Hey, we care? What would it look like if somebody was reaching out to say, we care all the time, so that when the tragedy happens, because it's inevitable, we're going to have those happen? Along the course of our careers, you already have someone who is a peer, with whom you've developed rapport, and you're very comfortable reaching out to them and being able to say, hey, I need help. Because vulnerability is not a trait that a lot of physicians carry in spades. And so the ability to develop that when times are good, so that you haven't, you have some of that emotional bank account, if you will, so that when times are not good, you don't hesitate when I went live with it. So I had piloted it for six months in my own health system, and around the country with a few other folks, for six months prior to rolling it out, it ended up that the website went live in February of 2020. So literally, six weeks before the pandemic, amazing program, the program went live both both amazing and unfortunate, in some ways, but had some really good early uptake from folks who had some influence, and so was able to get some visibility.
Dr. Christopher Landrigan 07:35
While there are certain pieces of the way that doctors and nurses gathered data, when patients come into the hospital, and it's pretty standardized, you know, the way that we all ask patients about what's going on, sort of, you know, the history and tell me about your past medical problems, things like that, in fact, you know, from a patient perspective, there's sometimes driven crazy by being asked that same set of 20 questions by multiple people throughout the hospital. But you know, for all that, that initial data gathering is really standardized and exhaustive and formal.
Once you're through the doors of the hospital, there was really no structure by which information was passed from one nurse to the next, or from one physician to the next to change or shift or if you move around within the hospital. And we found over a decade ago now that that was leading to all kinds of medical errors and downstream problems. And so designed IPASS is a way to try to fix that, in their very early years, there was a lot of, of kind of the quality improvement and patient safety movements, there was there was a lot of effort on trying to get clinicians just to wash their hands, right? If we could just get people to wash their hands more consistently, we prevent all kinds of hospital acquired infections. And it's true, you know, if you can get people to wash your hands more, it does help a lot, actually. But, but a lot of those, those interventions were sort of sort of dead ends, we just sort of felt like you were beating a beating a dead horse. In some ways, it was kind of hard to make progress.
And then a group of clinicians, initially at Johns Hopkins, and then there were there programs that help happen and elsewhere in the country began to think of this idea of bundle, you know, let's not just focus on hand washing, but let's think about all of these different little steps we could take that together would would prevent infection. So yes, let's focus on hand washing. But let's also think about things like, let's make sure that we optimize the use of sterile barriers, when we're putting in a central line, let's make sure we don't have those lines in for any more days than is necessary. Let's let's try to avoid sites that we know from literature are a little bit more dangerous, like putting in a in a femoral line, for example, versus putting in an arm, you know, putting in the leg instead of the arm, things like that. And that combination of little steps altogether.
All of a sudden, we were seeing 80% reductions, 90% reductions in the frequency that that hospital acquired infections were happening, you know, just this massive change where the hand washing, you know, being on the hand washing strategy wasn't working that well at all. And so, so for iPass, as we began thinking about the problem of communication in hospitals, we tried to take a page from that playbook. So for iPass, as we began thinking about the problem of communication in hospitals, we tried to take a page from that playbook and say, you know, What would a bundle look like for handoff communications? Right? I mean, we want people to speak to one another differently, we want to think about how do we get the right information in there, but but it's not going to be enough just to sort of expect that they're going to do that. I mean, they need to, we think they need an organizing framework, they need to be trained and how to use that organizing framework, we need to think about all the little details of what happens during a verbal exchange of information. And we need to think about all the little details of what happens in a written exchange of information, you know, what's in the electronic health record? And how do all those things work together.
And so I pass was, was a bundle, it was this idea of let's let's make small interventions, and each one of those areas and see what they do in the aggregate. But I think we also knew from prior experiences, both our own and others that just putting together that synopsis that summary and kind of dropping it into the wild, all by itself was not gonna do anything. We knew that we needed to combine that with a change management plan, you know, how do you train people to use this thing, once they've been trained in how to use it? We believe we had to do workplace based observation and feedback, basically an audit back type of an approach to get people to really use this and give them feedback on how well they were doing. We had to have leadership support within institutions, we had to have a campaign across the institution, all these different pieces had to come together. So really thought of I passes that whole packet, the whole thing, right? It's not just the mnemonic, it's the mnemonic plus the changes in verbal process, changing computerized written process, and then the, the surrounding structure. And so when we did all that together, and we intentionally did it all together, we didn't try to separate out the individual pieces. We found in an initial pilot study this really rapid drop off in medical errors at my institution. And then that became the preliminary data for a larger federally funded study where we rolled this out across nine pediatric hospitals in the US and Canada, and found a 30% drop off and injuries due to medical errors and process nine sites.
