Patient care your focus-but what about your practice?

January 1, 2007

The new Web-based Physician Practice Patient Safety Assessment (PPPSA) tool is helping physician practices to systematically evaluate the effectiveness of their patient safety practices, as well as implement practices to minimize risk.

Dermatology and other practices can download the free tool, which was developed by the Medical Group Management Association (MGMA), Health Research and Educational Trust (HRET) and Institute for Safe Medication Practices (ISMP), and funded by a Commonwealth Fund grant.

For $200, practices can submit their findings to see where they rank among other practices nationwide, have their data expertly analyzed and receive a workbook that identifies potential problem areas and pathways for improvement.

It became clear to Terry Hammons, M.D., when he worked as a lead physician at two academic centers in charge of improving patient safety about seven years ago, that improving fairly straightforward processes of care could significantly impact patient safety. Today a senior fellow at MGMA and one of the assessment's developers, Dr. Hammons says the PPPSA is among the first such tools specifically for clinical practices and not hospitals.

"Practices using the PPPSA analyze their clinical support systems and the proper procedures for coordinating patient care, tracking patients and their clinical information. For example, it answers the questions: 'Do we have a system in place that will reliably keep track of the lab tests? When the results come back, do we inform patients in a reasonable time period about whether they are normal or abnormal?' " Dr. Hammons says.

Other areas

Other areas that the PPPSA focuses on are the processes for: prescribing, storing, labeling, purchasing and dispensing medication samples; conducting in-office surgery, including sedation and anesthesia; assessing caregiver qualifications; educating patients; and managing the practice and culture to create an environment of safety.

Especially ambulatory and physician practice sectors need systems in place for ensuring patient safety because the care can be so disconnected.

"Patients who go to a practice might be sent to a lab or referred to another physician. If you do not have a good system in place, it is hard to keep track of everything," Dr. Hammons says.

Dermatology practices are particularly vulnerable to errors in the areas of medications and pathology, according to Dr. Hammons.

"Dermatologists use some big-time medications, such as methotrexate for psoriasis. They do send out a lot of pathology from skin biopsies, which they need to be on top of. I think another patient safety area that is particularly interesting to dermatology practices is knowing whether you have reliably communicated with patients about how to take a drug, for example. One of my favorite tried-and-true patient safety practices is asking whether the patient will be able, financially and physically, to fill the prescription or acquire and use a device," he says.

Dr. Hammons recommends that physician practices develop a multidisciplinary team to sit down for a few hours and go through the assessment.

"It is more effective if you get doctors, nurses, administrators and others together because different people know different things," he tells Dermatology Times.

The assessment process, alone, is an eye-opener, according to Dr. Hammons. Practices get a feel for where they are in managing patient safety and they communicate. The hard part, he says, is putting patient safety practices in place.

"It really does require an investment of time and a commitment to improving the way we do some things that seem almost mundane but are important," Dr. Hammons says.

Going through the assessment and implementing better patient safety practices can help to shield physicians from lawsuits. Physicians' practices also run more smoothly when doctors and staff are on top of results and patient care, and patients appreciate it when their doctors take steps to create safer environments, according to Dr. Hammons.

The assessment's developers are hoping to use the data to benchmark practice-based patient safety. Some data already exists because 200 MGMA physician-member practices were involved in testing the assessment before its launch in October 2006.