Drivers to improving clinical outcomes

Drivers to improving clinical outcomes Sue Creehan opened the symposium by reminding the audience of the current pressures that healthcare organisations face in delivering optimal care to patients. Currently, healthcare organisations are driven to improve clinical outcomes while at the same time remaining financially solvent in a competitive healthcare arena. There is now a focus on becoming what is commonly known in the USA as a ‘high reliability organisation’ (HRO) — and, while the term may not be widely used elsewhere in the world, there is a need for ‘high reliability’ healthcare providers. These organisations must now focus on safety, quality and patient satisfaction in every service they provide. Excellence comes when safety, quality and patient satisfaction are embedded into the care delivered, Sue asserted. Most healthcare organisations are undergoing significant change to meet these standards, thanks to demands from several groups including external stakeholders (public, government, advocacy groups and health insurers) and internal stakeholders (clinical practitioners, executives, and research, quality improvement and finance departments). Gone are the days when hospitals can expect to be paid for poor performance. Pressure injuries (PIs) [Box 1] pose multiple clinical, economic and patient-centric challenges and there is an increasing need to drive down their numbers as research suggests that 95% of PIs are known to be preventable (Hibbs, 1989; Hibbs, 1998). The success of prevention programmes depends on an understanding that different patients in different hospital settings can have very different needs. When patients are admitted to hospital, risk assessments should be undertaken to identify susceptibility to PI and preventive interventions should be put in place for the duration of their hospital stay. Interventions should be escalated as the patient’s risk increases and likewise may be adjusted as risk decreases. The key to establishing a comprehensive prevention programme is through thorough understanding of evidence-based strategies that can be translated and embedded into practice, and that are instilled throughout the organisation from the boardroom to the bedside. Everything possible should be done to prevent PI in patient populations and/or those in specific clinical settings regarded as being at a relatively high risk; for example, bariatric, critically ill, older or paediatric patients; individuals in the operating room (OR); patients with spinal cord injuries; and patients in palliative care. Authors (clockwise from top left): Paulo Alves, Sue Creehan, Amit Gefen, Nick Santamaria and Chenel Trevellini