Medical Early Warning System

"For patients, it would be a complete game-changer. It could not only mobilize and bring much safer care for patients, I think it rebuilds confidence of Canadians in their health-care system."
Anne Snowdon, head, University of Windsor, World Health Innovation Network

"I absolutely believe this is the way we need to go. The grocery business is way ahead of us ... "
"We need to standardize, we need to be bar coding, we need to be tracking."
"Although we've made lots of great gains [in preventing 'adverse' hospital incidents], we're still [inadvertently] harming people at an alarming rate."
Chris Power, CEO, Canadian Patient Safety Institute

The patient’s arm band is scanned (enlarged view). (Courtesy of CHRISTUS St. Patrick Hospital.)

How alarming might the rate at which inaccuracies, carelessness and lack of alertness take the lives of patients in the care of hospitals? A study undertaken in 2004 based its analysis on a representative sample of hospital charts to extrapolate from them results reflective of the entire hospitalization system, reaching the conclusion that between 9,000 and 23,000 people die as a result of preventable "adverse events" that occur in hospitals annually.

Because this is a startling public admission and because hospitals, their administrators and medical workers know that they have a responsibility to make every effort to improve these dismal statistics and to ensure that patients entering a hospital for treatment or surgery have confidence in the medical professional people they are entrusting their lives with, an effort has been made to improve outcomes. Even so, the efforts undertaken have proven insufficient to the need.

Needless to say, this is a public health and safety-security issue that is not a Canadian monopoly. The issue speaks to the fact that human beings make errors and those errors in this context, are humanly costly. Errors of such a medical nature represent health care's most intractable, deadliest concern. Everyone who enters a hospital for medical care believes they will receive the needed care, and live to tell about it.

A new report has been recently released speaking to a move to change health care by making it less expensive, more transparent and above all, safer. And the medium through which this issue is to enter the health care field is the bar code used universally in business and specifically by supermarkets; supply chain management. The proposed course is to make use of bar codes unique to drugs, medical devices, nurses, physicians and their patients.

Medications from a bar-coded arm band are compared with those in the computer system. (Courtesy of CHRISTUS St. Patrick Hospital.)

This would result in facilities such as hospitals being able to digitally monitor and track treatment; in effect, the creation of an "early warning system", fending off errors and resulting in greater confidence throughout treatment stages. A system such as has been envisaged by Anne Snowden, author of the white paper, would be capable of producing an objective record, an electronic one not blurred by human interface of faulty memories and deliberately self-protective omissions.

Specialized devices similar to those used in supermarkets would be designed to scan surgical instruments pre-surgery, to produce an electronic inventory ensuring that no instruments are unaccounted for, or/and accidentally left behind in the patient, post-surgery. A bar code scanned on the hospital bracelet worn by patients could reflect when the patient was turned last in the hospital bed, to aid in avoidance of potentially fatal bed sores.

Wandering dementia patients could be tracked by radio-frequency identification technology. Bar codes meant to match mothers and newborn babies would help to provide a preventive of the infant being discharged to the incorrect parents, and even disrupt any nefarious plans to abduct a baby. Medications are already been bar coded in some Canadian hospitals, dramatically improving safety.

If and when all medical care provision could be electronically scan-ready, challenging the current system to transition to a more accurate, albeit more costly one, the move is seen as a sure-fire method to improve and enhance current practise. In effect, most health care products do have bar codes placed for use by manufacturers and distributors which, once entered into a hospital setting are no longer utilized.

The major proposal by Anne Snowdon is the use of patient wristbands to provide access to digitized medical information to be cross-referenced to provided medical treatment. These are already being pioneered in some American hospitals. The drug systems that have been implemented in some hospitals work through an alert sounding when medicine or dosage or timing fails to match the prescription for the individual patient.

At hospitals in London, Ontario, once the system was in place, the administration of incorrect drugs fell by 90 percent while overall incorrect medication dropped by 30 percent. The vision is to apply a similar concept from the operating room to the diagnostic-imagine suite where patient bar codes would be meant to stop surgeons from operating on the incorrect body part, or to sound a warning if metal implants become lethal once the MRI's magnetic field is activated.