Monday, July 2, 2018

The Joint Commission issues Quick Safety 42: Identifying human trafficking victims

 The Joint Commission issued a safety alert on identifying human trafficking victims on June 18 (see Quick Safety 42: Identifying human trafficking victims). The first paragraph is an attention-getter:

The United States is one of the largest markets and destinations for human trafficking victims in the world. If staff at your health care organization have not yet encountered a human trafficking victim, very likely they will. Knowing how to identify victims of human trafficking, when to involve law enforcement, and what community resources are available to help the individual is important information for all health care professionals.

The alert notes over 40,000 reports of human trafficking in the U.S. over the 10-year period 2007-2017, with the largest number of reports coming from California, Texas, Florida, Ohio and New York, and asserts that “Human trafficking is the fastest growing criminal industry in the world and is the second-largest source of income for organized crime.”

Part of the problem is one of recognition and the challenge seems to be both identifying and knowing how best to help victims.  Most victims or their families have been threatened with harm if they reveal their exploitation, in some cases the victim may not realize his or her rights in the host country, and often times the victim has bonded with his or her exploiter, a condition known as “trauma bonding”.  In addition to fear of physical harm, victims also keep silent due to shame or fear of being humiliated.

The alert provides a technical definition of human trafficking, citing the United Nations Protocol to Prevent and Suppress and Punish Trafficking in Persons, Especially Women and Children and a U.S. law, the Victims of Trafficking and Violence Prevention Act.  But perhaps more helpful, it identifies “at-risk” or the most vulnerable populations for human trafficking which include children involved in foster care, runaway and homeless youth, Native Americans, LGBTQ individuals, undocumented immigrants, among others.  Also particularly useful, the alert highlights health care problems most that may trigger a cause for concern.

So to repeat the stance of The Joint Commission: “Knowing how to identify victims of human trafficking, when to involve law enforcement and what community resources are available to help the individual is important information for all health care professionals.”  The alert provides some metrics for recognizing signs of human trafficking and guidance for when human trafficking is suspected.

In terms of recognizing signs of human trafficking, there are poor mental health or abnormal behavior (such as appearing fearful, avoiding eye contact and refusing treatment) and poor physical health (such as appearing malnourished or signs of physical abuse).  Other signs include not being in control of personal identification, not be allowed to speak for themselves, and inconsistencies in his or her story).

Regarding when human trafficking is suspected, The Joint Commission notes that every situation will be unique and that “it is important to use a victim-centered response.”  While not every victim will be ready to seek help, the Commission notes that “if a victim is a minor (under 18 years of age), the provider is legally obligated to contact Child Protective Services.”  Responses will also depend on whether human trafficking is suspected or if the patient has disclosed that he or she has been trafficked.  The Joint Commission offers options for each of these situations.  For example, the alert notes that if the patient indicates he or she has been trafficked “in situations of immediate, life-threatening  danger,” the provider should follow “institutional policies for reporting to law enforcement.”  Other “safety actions” recommended include providing the patient with options for services, reporting and resources and if your organization has a social worker – “utilize them”. 

What role could Patient Access personnel be expected to play?  Most likely Patient Access would become aware in the Emergency Department – so personnel could be exposed to the common signs and at-risk groups identified in The Joint Commission’s alert to increase general awareness.  Institutional protocols would govern who in the organization would be engaged once human trafficking is suspected or confirmed.  Patient Access personnel should know who to contact within the hospital so appropriate action can be taken. 

As Martin Muratore, CHAM stated, “The role would be interdisciplinary. If and when Patient Access became aware, they would need to ensure that proper notifications were made.  As with all crime and for victims of abuse, any person who has contact with the patient should immediately report to police and social services or the social work department of the organization.”  Muratore notes that in most cases it will be an actual health care provider in the clinical situation who first becomes aware of the abuse or trafficking. Brenda Sauer, RN, MA, CHAM, FHAM agrees: “The Patient Access professional should be able to identify and then report through their usual channels if they suspect abuse.  This is usually  telling a clinician or social worker of their suspicions.”  And Nancy Farrington, CHAM, FHAM confirms that it is most likely going to be a clinician who is in the best position to detect abuse, but that Emergency Department Patient Access may be in a position to notice signs and that reporting to clinicians or social workers is the appropriate response. Patient Access staff may become aware of these situations, especially in the Emergency Department. I would not expect Patient Access staff to report suspicions to outside agencies but rather to follow internal protocols to have providers, clinicians, social workers, etc. make an assessment and take action.”

The Joint Commission’s alert is worth a read and provides some actionable and educational material for staff.  Awareness and response will clearly involve multiple disciplines in the organization and emphasizing internal protocols in addition to the information provided in the alert is a good place to start.

Tuesday, May 8, 2018

NAHAM Suggests Best Practices for Joint Commission Proposal Regarding the Use of Distinct Naming Conventions for Newborns

The Joint Commission has developed a new element of performance to be added to the National Patient Safety Goal NPSG.01.01.01 applicable to hospitals and critical access hospitals that provide obstetric services, specifically labor and delivery, nursery care, and/or NICU services.  The proposed NPSG.01.01.01, EP 3 requires the use of a distinct naming convention for positive patient identification for newborns:

For newborn patients: Use distinct naming systems methods for accurate patient identification.
Note: Examples of methods to prevent misidentification include the following:
 — Distinct naming systems using the mother’s first and last names and the newborn’s gender (for example, Smith, Judy Baby Girl or Smith, Judy Baby Girl A and Smith, Judy Baby Girl B for multiples).
— Standardized practices for identification banding (for example, two body-site identification and barcoding).
— Establish communication tools among staff (for example, checking for two patient identifiers prior to medical record entries and visually alerting staff with signage nothing newborns with similar names).
— Utilize a second person prior to high-risk procedures for positive identification purposes. This could be a second medical professional or approved family member to verify patient name or medical record number.
The associated rationale for the proposal is to the point, with the last sentence seemingly a conclusion many in Patient Access will already have arrived at in an effort to ensure positive patient identity in the bold new world of portable electronic records:

Newborns are at higher risk of misidentification due to their inability to speak and lack of distinguishable features. In addition to well-known misidentification errors such as wrong patient/wrong procedure, misidentification has also resulted in feeding a mother’s expressed breastmilk to the wrong newborn, which poses a risk of passing bodily fluids and potential pathogens to the newborn. A reliable identification system among all providers is necessary to prevent error.

In fact, NAHAM has long supported the general rationale and principle of NPSG.01.01.01 requiring at least two patient identifiers in the clinical setting; in fact, NAHAM has advocated for the development and implementation of robust patient identity integrity programs for use throughout healthcare facilities, recognizing that hospital registration is the front line for ensuring the patient is positively identified, matched with existing healthcare records, and directed to the appropriate clinical setting.  NAHAM-recognized best practices include multiple patient identifiers to achieve this goal, and NAHAM’s 2016 publication of its Best Practice Recommendations for the Collection of Key Patient Data Attributes seeks to drive an across the board adoption of practices focusing on five essential data points for patients: names, address(es), phone number(s), date of birth, and gender.  Working with the Office of the National Coordinator for Healthcare IT (ONC), NAHAM offered its Best Practice Recommendations emphasizing that data integrity through robust collection and recording protocols plays an essential role in patient care and identification in the clinical setting.  Acknowledging the importance of registration in positive patient identification, the ONC developed the Registrar Playbook based on NAHAM’s data collection recommendations. 

Positive patient identity includes the need for consistent naming conventions throughout all healthcare settings, and this has become increasingly important given the great diversity in the U.S. population and cultural and ethnic influences on family names, given names, and preferred names. 

Of interest to Patient Access, the new element of performance, “Use distinct naming systems methods for accurate patient identification,” offers the following example using the mother’s first and last names and the newborn’s gender as a compliant naming convention: “Smith, Judy Baby Girl,” or in the case of multiple births: “Smith, Judy Baby Girl A” and “Smith, Judy Baby Girl B.”

This convention or other very similar ones are generally employed in hospitals today, recognizing, as has the Commission, that the use of nondistinct naming conventions have been associated with increased risks of wrong-patient errors, and recognizing the unique circumstances involved with newborns.  The Commission has also provided previous guidance regarding the use of temporary names that are not distinct enough to address the risks of misidentification.  See, Temporary names put newborns at risk. Quick Safety – Issue 17 (The Joint Commission: October 2015).

The Commission’s proposal seems to provide flexibility for each hospital to adopt its own specific naming convention for newborns so long as it is distinct, is used consistently, and includes at a minimum the elements included in the Commission’s example noted above.  This allows a hospital to ensure that compliance with proposed NPSG.01.01.01, EP 3 will be appropriately linked to its current systems and its larger set of protocols associated with patient records and data integrity.  That’s important, even recognizing the long-term goal of the adoption of common patient data collection protocols, including naming conventions, across all healthcare settings.

At least until such time as all hospitals are using common data collection protocols and all IT systems in use can support specific data fields, this flexibility allows hospitals to adopt even more robust practices from which new best practices may emerge.  In the case of a naming convention for newborns that will support NPSG.01.01.01, EP 3, there is the potential for space limitations for characters on a newborn’s identification band, bracelet, specimen labels, and in some electronic systems.  Using the format of mother’s last name – mother’s first name – the word “Baby” followed by the newborn’s gender and birth order (when applicable) (e.g., “Smith, Judy Baby Girl A”) risks losing essential identification information when the mother has a name with over a certain number of characters.  Hyphenated last names, as well as lengthy names based on cultural and ethnic norms, are a reality that can and should be taken into consideration.

To address the space limitations noted above, NAHAM has suggested not using the word “Baby” in the naming convention for newborns and using a different order for the key identification information: mother’s last name – newborn’s gender – newborn’s birth order – mother’s given name.  For example –

“Dougherty, Girl A Mary Elizabeth” and “Dougherty, Girl B Mary Elizabeth”

“Vaidaynathen, Girl A Gowriprabha” and “Vaidaynathen, Girl B Gowriprabha”

“Penobscott-Smith, Girl A Penelope” and “Penobscott-Smith, Girl B Penelope”

These, as examples of an alternative distinct naming convention to positively identify newborns, should be consistent with proposed NPSG.01.01.01, EP 3, and will ensure that the newborn’s gender and birth order are not at risk of being “dropped” as the final characters in the newborn’s identification by banding,  labeling, and other systems.  This order ensures the mother’s last name and all or a portion of the mother’s first name will be captured.

Compare the more commonly used convention and the emerging practice introduced above (where the underlined characters risk being “dropped” because the number of characters exceeds, in these examples, 25) –

Dougherty, Girl A Mary Elizabeth
Dougherty, Mary Elizabeth Baby Girl A

Dougherty, Girl B Mary Elizabeth
Dougherty, Mary Elizabeth Baby Girl A

Vaidaynathen, Girl A Gowriprabha
Vaidaynathen, Gowriprabha, Baby Girl A

Vaidaynathen, Girl B Gowriprabha
Vaidaynathen, Gowriprabha, Baby Girl A

Penobscott-Smith, Girl A Penelope
Penobscott-Smith, Penelope, Baby Girl A

Penobscott-Smith, Girl B Penelope
Penobscott-Smith, Penelope, Baby Girl B

Given the important role of identification banding and labeling of specimens and medicines in the clinical setting, NAHAM sees an opportunity for hospitals to ensure that their systems for banding and labeling be able to capture the most important identification information for newborns, recognizing that the mother’s first and last names may cause the entire naming convention to exceed the available spaces on bands, bracelets, and labels.

Monday, April 23, 2018

Conference Preview: The Impact of Standardizing Best Practices in Patient Financial Communications

Session Title: The Impact of Standardizing Best Practices in Patient Financial Communications

Presenters: Patti Consolver, FHAM, CHAM; Yvonne Chase, MBA, CHAM, FHAM, MCA/MCF; Michelle Fox, DBA, MHA, CHAM    
Learning Lab: Series 5

Date/Time: May 4, 5:00 p.m.

About the Learning Lab

New research from Future Market Insights predicts an annual compound growth rate of 6.9 percent for the global healthcare revenue-cycle management software market over the next five years. A recent survey by Navigant and HFMA revealed similar findings, with nearly three-quarters of CFOs and revenue cycle executives planning to spend more on revenue cycle technology in 2018. 

So what are executives looking for in this investment? 

The answer, according to these sources, is to become interconnected. Particularly, to align revenue cycle efforts toward the dual aim of improving financial standing and increasing patient engagement in the changing reimbursement environment. With a continuing increase in consumer responsibility, providers need new ways to holistically educate patients about financial responsibility and prepare their organizations to support the effort.

Disparate revenue cycle systems, if not integrated, prevent hospitals from forming a complete and searchable view of information surrounding the patient. The resulting gaps compromise care quality and efficiency and put hospital outcomes and performance at risk. Technology and patient engagement intersect when disparate data can be shared so that all providers have access to the same information regarding the patient — clinical, financial and everything in between. 

Consolidating revenue cycle data into a unified, connected platform promotes operational efficiency, financial integrity and the patient experience. By capturing and integrating patient financial data from disparate sources, leaders can reduce unnecessary duplication and ensure the accuracy and consistency of information provided at each touch point. This helps form a comprehensive view of patient information exchanged across departments and entities, standardizing best practices and improving system outcomes.

The organizations represented on this panel have implemented strategies to standardize processes among their respective health systems. These include centralizing system-wide Patient Access functions, consolidating patient financial information into a single platform and ensuring that each entity addresses patients in the same way. 

Best practices for communication are emphasized in employee job descriptions, education and performance evaluation. At each facility, patient-staff interactions are recorded for quality assurance, training and reproduction of best practices. The end goal is to create a consistent and predictable standard for patient financial communication across the enterprise.

An enterprise approach to technology with links across departments and entities helps providers optimize workflow and reporting to create a consistent experience across the system. Join this panel of Patient Access experts to learn about the impact of standardizing best practices in patient financial communications and how this approach can work for your organization.

Conference Preview: The Omnichannel Approach to Unlocking Access

Session Title: The Omnichannel Approach to Unlocking Access

Presenters: Pamela Ravare

Learning Lab: Series 3

Date/Time: May 5, 10:15 a.m.

About the Learning Lab

I think we would all agree that we feel the pressure of consumerism as it relates to establishing better access to care. During this learning lab, I look forward to sharing how our organization has shifted its access-related efforts to a more systematic, omnichannel approach to unlocking access.

Our access vision is to establish our physician organization as the national leader for providing unparalleled access for our patients. Our working vision tenets for Patient Access start with meeting and exceeding our patients’ expectations with a differentiated yet predictable experience. In addition, we strive to maintain the integrity of our teaching and research mission while enhancing the patient experience and organize our operations to seamlessly deliver patients to our physicians, thereby liberating their time and expertise to provide care.

I would emphasize the importance of taking a hard look at access challenges from the patient’s perspective. Where are your access breakdowns? Like most hospital organizations, we faced challenges with pigeonholed leadership, fragmented decision-making and uncoordinated efforts with access initiatives in the organization.

Solving access challenges is a multidisciplinary effort. We had to gain a full understanding of our patient struggles with accessing care, identifying those areas and locations with bottlenecks around appointment scheduling, arrival and registration, wayfinding and provider delays. 

Our organization has undergone an access leadership evolution this past year. We have transitioned access accountability from a practice level to a medical group level by defining and differentiating access leadership in practice operations. We have leveraged technologies, centralized/standardized workflows and we have taken an omnichannel approach to appointment routes (online, chat, virtual visits, walk-ins and call center scheduling).

Unlocking access through open direct scheduling makes it easier for your patients to receive care and connect with your organization. Your overall approach will yield greater results in patient satisfaction and increased revenue.