Jason Adelman, MDNamed one of the "50 Experts Leading the Field of Patient Safety" by Becker’s Hospital Review, Dr. Jason Adelman is an Assistant Professor (Hospital Medicine) and Patient Safety Officer for the Montefiore Health System. He began his career at Montefiore as a hospitalist in 2003. After completing a master of science degree from Albert Einstein College of Medicine’s Clinical Research Training Program in 2006 and the AHA-NPSF Patient Safety Leadership Fellowship in 2011, he was selected to be a Senior Fellow of the Health Research & Educational Trust (HRET), the research arm of the American Hospital Association. He is a member of the National Quality Forum (NQF) Committee on Patient Safety Complications, and the Editorial Boards of the Journal for Healthcare Quality and the National Patient Safety Foundation’s Insight Magazine. Dr. Adelman is also a member of the New York State Department of Health’s Quality and Patient Safety External Advisory Committee.
"I was a doctor interested in using technology to prevent patient errors."
My father is a "techie" so I grew up around computers. My first job out of residency, I worked for a medical software company and had a meeting with Dr. Brian Currie, who told me about Montefiore’s progressive use of computers in the care of patients. I started working at Montefiore as an attending hospitalist in 2003; at that time my current position did not yet exist. I kept thinking about ways to combine my interest in computers with my medical career and, after completing a few side projects involving the use of computers to prevent errors, I was offered the position of Patient Safety Officer.
"Checklists are only the beginning."
The modern patient safety movement began in 1999 when the Institute of Medicine issued the report "To Err is Human: Building a Safer Health System". This report identified that nearly 98,000 people were dying each year from medical errors—they were the country’s eighth leading cause of death.
The healthcare industry is like the airline industry because they are both complex and high risk. The airline industry has taken great strides to improve safety including the use of checklists to verify that every critical action is performed, a procedure now used in healthcare. Use of checklists is one basic systemic change in the health care process, but it is only the beginning. We must continuously review our medical errors, study their root causes, and devise strategies to prevent future harm.
"New technologies give rise to new issues."
New technologies increase the potential for unanticipated consequences.
A classic example resulted from the introduction of electronic medical record systems, which advanced the centralization and timeliness of patient information, greatly facilitating physicians’ ability to check other doctors’ notes, order medications, and read test results. Much of my recent research centers on the unintended consequence that the use of electronic medical record systems can introduce wrong patient errors. For example, at any given time a doctor may have many open tabs, each representing the medical record of a different patient. Along with this ease of access to a patient’s record comes an increase in the chance of inadvertently entering an order for the wrong patient.
Complex systems are susceptible to errors. Our job is to continually study these errors, attempt to identify root causes, and make systemic changes that eliminate or minimize them.
Our greatest challenge...
One of Montefiore’s great strengths is its diverse patient population, which provides a true cultural medley, a wide-ranging disease mix, and endless learning opportunities. The diversity of language in this population presents a significant communications barrier. Many patient safety initiatives start with collaboration between medical providers and their patients, but to make this happen we need to be able to communicate effectively. Let’s take falls prevention as an example. If I tell a patient to use a bedpan but he or she refuses, then a negotiation needs to take place—perhaps he or she will agree to press the call button and wait for assistance. If a language barrier is present, even if we use a phone translator, this becomes much more difficult. Engaging patients and their families and/or proxies as advocates is a critical component to the patient safety process, and clear communication is an important part of that.
Our greatest successes…
I am excited by how Montefiore is emerging as an institution that operates within a “Just Culture” framework. The degree of professional skill required in practicing medicine is so high, and the potential consequences of the smallest departure from established standards of practice are so serious, that one failure can literally mean life or death. Physicians, pharmacists, nurses, and other medical professionals operate under this pressure every day. Dr. Lucian Leape, a professor at Harvard School of Public Health and one of the founders of the modern patient safety movement, said that the single greatest impediment to error prevention in the medical industry is that we punish people for making mistakes, and I agree wholeheartedly. Rather than assuming that a mistake—even a fatal one—occurred due to a "bad doctor" or a "bad nurse", patient safety should be approached by gaining a better understanding of the system, how it allowed for that error to happen, and what checks could have been done to eliminate missteps or omissions.
"That annoying mother with the endless questions? She's our best friend."
Participation of family members and friends can be an important ingredient to achieving improved patient safety. Quite often they are the only constant factor, the advocate, for patients who are too sick or too stressed to understand what is usually an overwhelming amount of information. In my own experience, young to middle-aged adults often assume the role of caregiver and are key agents for improving patient safety. They are the mothers and fathers watching out for their children, and the sons and daughters caring for their parents. They are a second set of ears, they take careful notes, and they ask lots of questions.
"Our best insights arise when we examine the root of our own errors."
Leading patient safety institutions need to contribute to the science of patient safety, and we have done this. Some of our most fascinating insights arise when we test our own interventions, examining why and how errors happen in order to determine whether we have developed an effective intervention. My colleagues and I have published a number of scientific papers on innovative approaches that improve patient safety, with a particular focus on the use of technology to prevent medical errors. Some examples of our patient safety research projects include determination of interventions to prevent wrong patient errors, deep vein thrombosis, catheter-associated infections and patient falls.
Quality improvement and patient safety stand at the core of Montefiore's clinical mission to heal, teach, discover, and advance the health of the community we serve, and science at the heart of medicine is the driving purpose behind Albert Einstein College of Medicine. I am encouraged by the achievements made in our completed research projects, and excited about the projects we have in the works. With every medical error root cause we identify, every intervention we implement, and every systemic improvement we make to our system of healthcare, we are saving lives, and I cannot think of a better reason to come to work.
Over the past eleven years, I have seen the culture at Montefiore grow to value the system side of patient safety, with strong support from senior-level administrators like our President and CEO Dr. Steven Safyer and our Executive Vice President Dr. Philip Ozuah. Patient safety has become a priority for all staff at every level of Montefiore.