VA sends Spot to fetch data

VA sends Spot to fetch data

The simple sentence 'See Spot run' has taken on new meaning at the Veterans Affairs Department's National Center for Patient Safety in Ann Arbor, Mich.

A custom database application, dubbed Spot after one developer's St. Bernard puppy, is running at the center to root out the causes of close calls in VA patient care.

Starting in the summer of 2000, in-house developers began work on Spot. They wanted to replace a Microsoft Word template for root-cause analysis with a database application that would make it easier to input information and share it in confidence with other VA facilities.

They also wanted to streamline reporting of patient safety-related incidents as required by the Joint Commission on Accreditation of Healthcare Organizations.

Spot uses two Microsoft Corp. database management systems, Access and SQL Server. All VA health care facilities have Access, so no new licenses or purchases were needed, said Linda Williams, a computer specialist who led the four-person development team.

Separate password

Most RCA data and the SQL Server database reside on the center's file server. Other components are on computers used by the facility's patient safety manager, the risk manager and others who perform root-cause analysis.

Each Spot user gets a username and password that differ from the ones used to access other applications.

Spot warns at log-in that its documents, records and other information are part of a so-called focused review and therefore are confidential and privileged under federal regulations.

Workers doing root-cause analysis can temporarily transfer individual RCA cases by floppy diskette to a standalone or notebook computer, but they get only a temporary password for a particular case and can see no others, Williams said.

The information about an adverse patient event or a near miss is available only to persons at the facility concerned. When a case is completed, the patient safety manager or risk manager must 'de-identify' information about the patient, the location and the staff before transmitting it over a secure line to the main database that will store RCA data for all VA sites nationwide.

The heart of Spot is the main menu, said Diana Grayson, a computer specialist who led the technical analysis.

To log in a close call, users fill out a template of 22 items including case and station numbers, event date, type of event such as a fall or a medication error, actual and potential safety assessment code scores for severity and probability, and personnel involved.

Flow charts

Spot users also have a drawing tool to develop flow charts outlining how and when a close call happened.

A number of VA facilities had the Microsoft Visio diagramming program available, but 'we didn't want people to have to learn to drive,' Grayson said.

The team searched the Internet for an alternative drawing tool and found that a French company, Lasalle Technologies, had an ActiveX plug-in for use with Visual Basic.

The customized drawing tool lets a user generate a flow chart by filling in a screen that follows the sequence of events, supplemented with notes and flow chart branches.

'What is great about this tool is that the content of each of the little boxes is searchable,' Williams said.

'All the data from the flow chart is stored in a table in the database,' Grayson said. 'Instead of being one blocky object, they're all individual' items that can be searched.

Spot is coming out in four stages. Last winter it was tested at five facilities over the Veterans Integrated Service Network in Florida. The second stage was testing at 30 sites with one volunteer from the remaining VISN facilities. Currently, 130 sites are testing the software, and the final phase of rollout to all 172 sites is expected later this year.


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