Using the SAFER Guides to Improve Patient Safety and Medical Risk Management
July 21, 2022
By Arvind Kumar and Dr. Abraham Morse
Incorporating the new Center for Medicare & Medicaid Services (“CMS”) SAFER Guide recommended practices into the configuration of your electronic health record (“EHR”) system can produce substantial benefits beyond compliance. These recommendations represent a roadmap for reducing errors in patient care, leading to a reduction in patient harm, medical malpractice and other financial risks.
Of the nine SAFER guides, the four “clinical process guides” (#s 6-9) include many powerful countermeasures that can be applied across the continuum of care. They are focused on patient assessment, diagnostic decision-making, test ordering and interpretation, and follow-up in provider/provider communications.
While the new CMS requirements mandate an annual self-attestation as to whether you have completed each specific recommendation, there is currently no penalty associated with responding in the negative. However, devoting time and resources to meeting the SAFER Guide recommendations can address critical gaps in your institution’s patient safety process and program.
This can provide a potential competitive advantage by reducing patient harm, limiting medical liability exposure, increasing clinician and staff confidence and satisfaction, and protecting your organization’s brand in the marketplace.
Where Malpractice Claims Happen in the Process of Care
Throughout the delivery of patient care, there are many areas of risk that can be mitigated by optimizing your EHR system, as shown in Table 1. The left-hand column enumerates a typical 12-step “patient journey.” The column on the right contains the frequency, of which each discrete step is associated with medical malpractice claims from a whitepaper published by CRICO, the malpractice and risk-prevention research arm of the Harvard Hospital Systems. The data was extracted from a national cohort of high-performing hospitals that contribute cases to CRICO’s claims comparative database:
|Process of Care Step||% of Malpractice Cases|
|1. Patient notes problem and seeks care||1%|
|3. Patient assessment/evaluation of symptoms||31%|
|4. Diagnostic processing||35%|
|5. Order of diagnostic/lab test||31%|
|6. Performance of tests||3%|
|7. Interpretation of tests||23%|
|8. Receipt/transmittal of test results (to provider)||5%|
|9. Physician follow up with patient||18%|
|10. Referral management||21%|
|11. Provider-to-provider communication||12%|
|12. Patient compliance with follow-up plan||17%|
Table 1: Process of care map with associated frequency of med-mal claims.
Where the SAFER Guides Make a Patient Safety Impact:
Each SAFER Guide recommendation can impact more than one process-of-care step, thereby multiplying its effect on preventing patient harm and decreasing financial risk. The table below maps two example recommendations from each of the four clinical process SAFER Guides and links those recommendations to the individual process of care step(s) that can achieve a safety improvement and risk reduction due to its implementation.
Table 2 shows examples that demonstrate the connection between SAFER clinical process guide recommendations and achieving reductions in common medical errors throughout the patient journey. The powerful risk and safety countermeasures contained in the SAFER clinical process guides can help your organization reduce patient harm and lower financial risks related to errors in care delivery. These improvements can translate into a competitive advantage through reduced patient harm, decreased financial risk and increased staff satisfaction.
|SAFER Clinical Process Guide||SAFER Recommended Practice||Process-of-Care Step Impact|
|#6 Patient Identification||An enterprise-wide master patient index that includes patients’ demographic information and medical record number(s) from different parts of the same organization to identify patients.||1, 5, 6, 8, 10|
|#6 Patient Identification||Information required to accurately identify the patient is clearly displayed on all computer screens, wristbands and printouts.||5, 7, 8, 9, 11|
|#7 Computerized Provider Order Entry with Decision Support||Coded allergen and reaction information, or No Known Allergies (“NKA”), is entered and updated in the EHR prior to any order entry.||2, 4, 5, 9|
|#7 Computerized Provider Order Entry with Decision Support||Evidence-based order sets are available in the EHR for common tasks/conditions and are updated regularly.||5|
|#8 Test Results Reporting and Follow-Up||Workflows that are particularly vulnerable to mishandling of test results, especially critical ones, are identified. Back-up procedures ensure test results are received by someone responsible for the affected patient’s care.||5, 6, 8, 9|
|#8 Test Results Reporting and Follow-Up||Automated, non-interruptive results notifications, (also called in-basket alerts or flags), are limited to those that are clinically relevant in order to minimize alert fatigue.||3, 4, 11|
|#9 Clinician Communication||Workflows that are particularly vulnerable to mishandling of test results, especially critical ones, are identified. Back-up procedures ensure test results are received by someone responsible for the affected patient’s care.||5, 6, 8, 9|
|#9 Clinician Communication||Automated, non-interruptive results notifications, (also called in-basket alerts or flags), are limited to those that are clinically relevant in order to minimize alert fatigue.||3, 4, 11|
Table 2: Prospective process of care impact of implementation of example recommendations from the SAFER Clinical Process Guides, numbers 6-9.