Malpractice insurer pays -- to study risk prevention
$500,000 in grants to target ER safety, how patients depart, other care issues
The potential for errors being made during long patient stays in emergency rooms is among the medical dangers that will be studied through grants awarded to 10 doctors by the malpractice insurer for Harvard-affiliated hospitals.
Emergency room ''boarding" -- when patients are examined, treated, and admitted to a hospital, but kept waiting for a room -- is fraught with risk, said Dr. Shan Liu, an emergency-room doctor at Massachusetts General Hospital and a student at the Harvard School of Public Health.
Emergency room physicians and nurses, often swamped with high-priority cases, may not be able to provide proper care for a patient lingering in an ER, she said. Sometimes patients can be kept on a gurney for up to 48 hours, during which time they can be cared for by six different doctors, Liu said.
''As a physician, it worries me that we are potentially compromising patient safety," she said. ''The person's main story gets lost when you play telephone that many times."
Liu will use a $50,000 grant to study the medical records of 2,000 patients who stayed for long periods in emergency rooms at hospitals in the Partners HealthCare network. The work will produce statistics that will show whether the medical community's fears about boarding are justified.
Liu's $50,000 grant is one of 10 such awards doled out to individual doctors by the Controlled Risk Insurance Co./Risk Management Foundation, a nonprofit insurance corporation that covers 9,200 physicians and 450 doctors' office practices, as well as Mass. General, Brigham and Women's Hospital, and other Harvard teaching institutions.
The organization has a national reputation for studying its malpractice claims to find ways to reduce risk and improve care -- data it shares with member hospitals. This is the third year the foundation has awarded $500,000 in grants. It chose this year's 10 winners from among 65 applications.
Liu's work has the potential to be groundbreaking, said Ann Louise Puopolo, the insurer's operations director of loss prevention and patient safety.
''Doctors are concerned that boarding exposes them to increased liability in caring for patients in an overcrowded setting," she said. ''So far, no one has been able to quantify how often adverse outcomes happen under these circumstances."
While that project will study patients entering hospitals through emergency rooms, the organization awarded another grant, to Dr. Richard Balaban, medical director at Somerville Primary Care, to study ways to improve how patients depart from hospitals.
Balaban is developing a prototype discharge system that will include clearer forms and protocols for phoning patients 48 hours after they are sent home. He said such measures should prevent medication errors, missed tests, and other miscommunication.
If successful, the test, using 100 to 150 patients from Somerville Hospital, could be expanded to the entire Cambridge Health Alliance, which also includes Cambridge Hospital and Whidden Memorial Hospital in Everett, he said.
''Studies have shown that half of discharged patients don't understand their discharge plans," Balaban said. The potential for problems is growing worse because hospitals are sending patients home earlier in their recovery, which means they have more complex responsibilities to deal with on their own, he said.
Other grants were awarded to study reporting systems for pelvic sonograms, the benefits of disclosing medical errors, and the content of patient complaints.
Christopher Rowland can be reached at crowland@globe.com. 