Using CIRS to learn from mistakes before accidents happen

IT support of Netcetera increases safety for patients

System-supported processes that help recognize sources of errors are standard tools in high-risk industries. In the field of healthcare, they can save lives. Netcetera has added a CIRS module to eVisit, its system for patient data administration. It offers remarkably easy, platform-independent reporting of critical incidents in healthcare institutions. The innovative tool was developed in cooperation with healthcare informatics students at the Bern University of Applied Sciences.

Lower risks and costs thanks to Netcetera's user-friendly CIRS module that can easily be implemented in the existing IT environment.Hospitals are complex systems and vulnerable to complications. Human, technical and organizational errors can have fatal consequences. In times of frenzied activity, a diagnosis can be easily misunderstood, medications might be mixed up, or an equipment malfunction goes unnoticed. One out of every hundred stationary patients suffers serious health consequences as a result, according to Patientensicherheit, a Swiss patient safety foundation. This means that every year, between 700 and 1,700 people die in Swiss hospitals due to mistakes during treatment. Analyses have shown that many of these deaths were avoidable.

Lower risks and costs

Clinical risk management is thus essential for patient safety and healthcare quality. Systems for reporting critical incidents are an important tool; these are known as Critical Incident Reporting Systems (CIRS). They were originally developed for the aeronautics sector, but over the past few years, their use in the healthcare field has increased. They are meant to help learn from mistakes before accidents happen. Complications lead to high costs and human suffering, and they are a considerable strain on healthcare resources. Patients may be exposed to more pain and have to undergo additional treatment. Healthcare personnel is also affected.

CIRS allow employees to report incidents that exposed patients to unnecessary risks and to potential harm. Reports are made anonymously using an online form. Employees need fear no consequences to themselves. While entering the information, employees can already suggest solutions to avoid similar incidents in the future. The next step is an evaluation by experts and quality managers, who identify measures that may be required. Finally, the report is published in a CIRS portal on the Intranet. The objective is to use the insights from the near-miss incident to identify systematic changes to work procedures or structures.

Usability is essential for acceptance

Many different concepts and types of CIRS instruments are in development or in use in Swiss clinics. The amount of responses also varies. Not all employees have taken to the system in the same measure. This might be due to a lack of trust or due to an inadequate culture of providing feedback. However, employees might also be hesitant to use CIRS if the system is complicated or lacking in user friendliness and flexibility.

That is why the software company Netcetera has launched a new CIRS tool that fulfills not only clinical, legal and safety requirements, but is also simply built and easy to use across all platforms, in particular on mobile devices. Its Interaction Design is particularly innovative. The solution is based on the IT architecture of the eVisit product, which Netcetera developed in cooperation with the i-engineers of Zurich, the specialist for hospital document management.

With eVisit, cutting-edge technical tools are used to remotely keep digital patient files up to date and to allow doctors or nurses to supplement or manage patient data according to strict authorization criteria. The software allows end users to access relevant data from all manner of medical applications and data carriers. These might be therapy schedules, lab data, x-ray images or ECG recordings in special formats or from specialist applications. eVisit, the digital patient filing system, combines different processes and supports communication among users.

Productive cooperation with students

Netcetera's CIRS module is based on eVisit but can also be used independently. The application was developed in cooperation with the Bern University of Applied Sciences. Medical informatics students independently developed a functioning prototype as part of their final projects. The Baselland canton hospital tested this prototype and decided to put it into service. "The test run was so convincing that the hospital ordered the CIRS within a week," says Thierry Hafner, the Netcetera expert in charge. He provided technical support and advice to the students. Netcetera finished programming the application in record time in the Macedonian city of Skopje.

For Thierry Hafner, the result demonstrates that the Swiss industry can cooperate with academic institutions to develop products that meet market requirements. Thanks to the first impulse provided by the Bern University of Applied Sciences, Netcetera can now offer its CIRS solution. For Thierry Hafner, however, the most important positive effect for the company was the opportunity to demonstrate to students its leading role in the Swiss software industry: "We urgently need recruits, because hospital informatics specialists are rare in Switzerland."

Positive first reactions

Since early 2015, one of three hospital locations of the Baselland canton hospital (KSBL), which was merged in 2012, has been using Netcetera's CIRS in several areas of practice. That way, the highly complex, partially external earlier systems can be harmonized and replaced by the better solution. Those in charge were brought on board by the ease of sending a report even when operations are in full swing. "We are constantly pressed for time," says Christian Wilmes, who works in the medical controlling/quality department, "so too many questions in the form would be a hassle." The product's three tabs also make it easy to use for the administration, modification and publication of reported cases. Its implementation in the existing IT environment is also simple. It was more of a challenge to familiarize employees with the new tool.

Even though it was introduced only recently, the new CIRS is in active use at KSBL. The amount of reported incidents from participating clinics has increased. This is also because employees are more aware of the system now that it has been introduced.

New updates based on feedback

The Release 2.0 in September will contain small adjustments to the program. Reports will then be less author-oriented. This means that the focus will be more on the incident, or rather the patient. In addition, cases entered into CIRS records will be specific to departments, and additional statistical evaluations can be made. Further releases aim to enable sending a complete report to management.

Although CIRS are not required in every canton, they are highly important for hospitals, as they are necessary for accreditation as an educational institution for various healthcare disciplines. "If you are serious about the quality of your healthcare, you use CIRS," says Christian Wilmes. "It is no silver bullet, but rather an important tool that helps decrease critical incidents to a minimum."


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