Rheumatology Practices Need Sharp Focus on Patient Care Safety, Quality

“Culture is key to hardwiring more advanced levels of safety in our daily work—if you have physicians, or other team members, in your practice who are unwilling to change or think about new ways of practicing, you need to win them over or ask them to work elsewhere because change is our reality,” says Dr. Newman.

Safety work requires what Dr. Newman calls a teaming culture, in which all members of the team feel comfortable and willing to talk openly, respect ideas and agree on the value of always striving to improve safety.

Investigate a Better Way

A focus on research to improve safety is driving quality improvement work at Brigham and Women’s Hospital (BWH) in Boston, where

Sonali Desai, MD, MPH

Sonali Desai, MD, MPH, medical director of quality for the Department of Medicine and the medical director of Ambulatory Patient Safety for the hospital, is preparing to launch her team’s latest quality improvement project. The project goal is to standardize important verification steps necessary to safely prescribe certain immunosuppressant medications to rheumatology patients. These steps include confirming influenza and pneumococcal vaccination, confirming important baseline tests for infections, such as tuberculosis and hepatitis, and ensuring risk/benefit conversations about the medication take place with patients.

“This conversation is very important [because] our patients have a number of questions we want to address, but sometimes this conversation can take up all of the time in a clinic visit. We need to be sure to take the time to explain a medication’s risks and benefits but balance that with using a basic checklist approach to ensure we have reviewed and addressed key safety and quality issues, such as vaccinations,” Dr. Desai says.

In the forthcoming BWH quality improvement initiative, her team will seek ways to incorporate prompts for these verifications into the EHR in a way that is streamlined within physician and nursing workflows to prevent extra or duplicative work. She is collaborating with other departments (e.g., Pulmonary, Nephrology and Gastroenterology) that prescribe immunosuppressant medications to ensure there is a multidisciplinary approach.

‘Culture is key to hardwiring more advanced levels of safety in our daily work—if you have physicians, or other team members, in your practice who are unwilling to change or think about new ways of practicing, you need to win them over or ask them to work elsewhere because change is our reality.’ —Dr. Newman

A previous quality improvement project Dr. Desai led focused on implementing simple paper-based clinician reminders to verify patient influenza and pneumococcal vaccinations in four ambulatory clinic settings, including rheumatology, before prescribing medication, and results were promising.²