Why Clinical Analyst Review in Hospitals Is No Longer Enough

Care review performed in hospitals today by clinical analysts falls far short of addressing quality concerns.

What got hospitals through the last decade won’t get them through the next. The complexity of inpatient care, the density of regulatory requirements, and the speed at which leaders must act have outgrown the traditional quality-review model built around a single clinical analyst reading a handful of charts each month.

For executives responsible for finance, quality, and safety, the stakes are too high, and the opportunities too large, to keep relying on slow, retrospective, analyst-only audits.

The scale of harm and opportunity alone makes the case. A recent federal review found that roughly one in four hospitalized Medicare patients experienced harm during their stay, and nearly half of those events were preventable [1]. That’s not a long tail of rare events; it’s a system signal. Yet sampling a few charts after discharge, often just a few percent of admissions, can’t reliably illuminate where today’s risks are, much less prevent harm for similar patients in the hospital. The result is a persistent lag between what happened, what was learned, and what gets changed.

Even when manual chart audits are done well, they are slow, resource-intensive, and designed for sampling rather than coverage.

Consider the IHI Global Trigger Tool, a widely used method for detecting adverse events. It typically requires two trained reviewers and physician validation, and it takes about 20 minutes per chart, often on a small, statistically selected sample such as 20 charts per month [2,3]. For hospitals with hundreds or thousands of monthly discharges, that methodology produces valuable insights, but it reaches only a sliver of patients and delivers findings weeks to months after the point of care. It is not built for near real-time feedback to frontline teams or for scaling across an entire hospital.

Faced with these headwinds, everyday we force clinical teams to work hard to overcome the compounding friction and resistance to delivering great outcomes. They work through the underlying systems issues that impact care delivery.

Meanwhile, the knowledge burden has exploded. Hospitals are accountable to thousands of evidence-based clinical recommendations across specialties, plus accreditation standards and elements of performance from The Joint Commission, and federal Conditions of Participation. Keeping those requirements current and applied consistently is a full-time job in itself, with clinician falling behind on all of the applicable rules guiding care [5,6].

Expecting a single analyst to master all of that, interpret complex clinical narratives, and surface actionable issues across medicine, nursing, pharmacy, case management, and ancillary services is asking one person to play an interprofessional team, while working mostly after the fact.

Care has also become more interprofessional and more complex. Most inpatients present with multimorbidity; diagnostics and therapeutics involve tightly coupled handoffs; and outcomes hinge as much on coordination and follow-up as on any single clinical decision.

The National Academies concluded that most people will experience a diagnostic error in their lifetime, and it emphasized the need for system-level approaches and timely feedback loops to make diagnosis safer [4]. When quality review is isolated with one analyst, disconnected from daily workflows, it lacks the systems perspective, and the reach, required to address these cross-cutting issues.

Financial risk is inseparable from clinical risk. For hospitals paid under the Medicare inpatient prospective payment system, up to 6% of base operating DRG revenue can be affected by federal quality programs, 2% through the Hospital Value-Based Purchasing Program, up to 3% via the Hospital Readmissions Reduction Program, and 1% through the Hospital-Acquired Condition Reduction Program [9,10,11].

That is material exposure. While critical access hospitals are exempt from some of these programs, they face growing payer quality requirements, reputational stakes, and the same fundamental patient-safety risks. In all settings, leaders need timely, reliable signals on where to act, not retrospective summaries that land after financial and clinical consequences are already set. One medical error leading to a malpractice settlement could exceed a hospital's margin.

The pandemic further exposed the fragility of sampling-based assurance. After years of progress, U.S. hospitals saw setbacks in healthcare-associated infection rates during 2020–2021, including increases in central line–associated bloodstream infections, catheter-associated urinary tract infections, and MRSA bacteremia [12,13].

When risk can surge in weeks, not years, review systems must detect and route issues in near real time. Otherwise, clinicians and managers are left to fly by instruments that update only after the turbulence has passed.

It’s also important to name the practical constraints. A single analyst rarely brings all the perspectives required to understand and resolve complex issues: operational realities on a busy med-surg unit; pharmacy workflows tied to medication reconciliation; case management barriers affecting discharge readiness; documentation gaps with accreditation implications; EHR configuration quirks that shape what gets recorded and when. No single professional can cover all of that, consistently, across an entire hospital, especially when the method is manual, time-consuming, and focused on single encounters rather than patterns across multiple visits.

Clinicians, for their part, often receive feedback late, in aggregate, and disconnected from the patients on their list today. It’s not surprising that quality improvement feels like a long road to results, even when everyone is working hard.

A more effective approach starts with an interprofessional systems view, scaled by technology, and embedded in care. Instead of assigning an individual to read a small sample of charts after discharge based on suspected adverse outcomes, hospitals can continuously review care across specialties and settings, checking against current clinical guidelines and regulatory requirements, and routing findings directly to the people who can act now.

That means discharge issues, patterns and trends are visible to the charge nurse and hospitalist during morning huddle. Adjustments can be made daily. It means diagnostic follow-up risks surfaced to primary teams so corrective actions are implemented before impacting more patients. It means medication safety signals reaching pharmacy and nursing early enough to prevent harm. And it means leaders can see, in one place, which issues are driving length of stay, readmissions, revisits, HACs/HAIs, and value-based performance, so they can focus the organization on what matters most.

This is the reason based on decades of experience in quality that we built Eva, a software-as-a-service medical care review platform from EvaluCare. Eva moves quality assurance from the back office to the bedside by combining an interprofessional systems approach with continuous, standards-based review.

Its algorithms and content are trained against thousands of clinical guidelines and regulatory and accreditation requirements, kept current, and tuned to the type of review and outcome you care about, whether that’s reducing avoidable readmissions, mitigating hospital-acquired complications, or closing gaps that affect value-based purchasing and surveys. Instead of sampling, Eva can evaluate large volumes continuously, turning what used to be sporadic audits into a reliable flow of timely, actionable insight.

Equally important, Eva’s outputs are designed for clinicians and operators, not just quality departments. Findings land with the right role, hospitalists, nursing, case management, pharmacy, quality specialists, with clear context and next steps.

That closes the loop between detection and prevention and shortens cycle times from months to days. While every hospital’s results will depend on local context and execution, Eva is designed to support reductions in avoidable delays, harm events, and revenue leakage by making the most important signals visible and actionable where care happens.

Because governance matters, Eva also feeds a robust quality assurance program that hospitals may have in place, such as lean management systems or perhaps huddle boards. Risks and failures are escalated when necessary, tracked to resolution, and linked to the standards and measures you are accountable for, from The Joint Commission elements of performance to CMS value-based domains. That creates a single, shared source of truth for leadership and frontline teams, aligning daily work with external requirements and internal goals. And because Eva scales without requiring proportional staffing, it materially reduces the manual burden on analysts and clinicians while expanding the fraction of care under active review.

For executives, this approach delivers benefits on three fronts.

First, faster cycle times: near real-time clinical and operational feedback accelerates improvement on issues that affect safety and payment today, not next quarter. Second, better alignment: a shared view of quality signals helps huddles, rounds, and leadership focus on the highest-impact work across Joint Commission, CMS, and internal priorities. Third, ROI through both mission and margin: safer care and stronger performance on readmissions, HACs/HAIs, and value-based domains translate to fewer penalties, better rankings, and healthier capacity, without adding beds or staff.

With CMS changing the Star Rating to exclude hospitals from Five Stars if their safety domain is in the bottom quartile, the stake have never been higher for a hospital's quality reputation.

None of this diminishes the expertise of clinical analysts. It amplifies it. Analysts remain essential to interpreting complex cases, shaping interventions, and coaching teams. Yes, coaching teams at the bedside ideally. It maximizes their time beyond analysis, to improvement, and partnership with clinicians, not manually searching for needles in haystacks or trying to memorize every standard in an ever-changing stack of binders.

Eva takes on the scale and the speed, so people can focus on judgment and change.

If your quality reviews still depend on a single analyst and a small chart sample, consider what that model was designed for: a slower era, with fewer standards, less interdependence, and weaker ties between quality and payment. Today’s environment demands a system built for complexity, coverage, and timeliness. An interprofessional, standards-aware, clinician-facing review capability is no longer a nice-to-have; it’s the foundation for safer care and stronger performance. Eva from EvaluCare was built to make that shift practical and sustainable for critical access, community, and large hospitals alike. It is clinical assurance.

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Learn more at evalucare.net or contact info@evalucare.net.

About the Author

Jason Minor is a healthcare quality and transformation leader with nearly 30 years of continuous improvement experience. A Certified Lean Six Sigma Black Belt, Certified Professional in Healthcare Quality, Certified Professional in Patient Safety, and Certified Utilization Review Professional, he has led thousands of end‑to‑end improvement projects, mentored dozens of quality professionals, and pioneered healthcare AI SaaS innovations.

As Board Chair of the Vermont Program for Quality in Health Care, Jason has partnered with hospitals, non‑profits, and state agencies to elevate patient safety and care quality statewide. Previously, as Network Vice President of Quality at the UVM Health Network and through the Jeffords Institute for Quality, he guided the redesign of a system‑wide quality framework and led initiatives that achieved a number‑one patient safety ranking among the nation’s top academic medical centers.

In 2020, Jason founded EvaluCare to help organizations shift from episodic improvement to a robust quality assurance approach.

EvaluCare’s Eva platform leverages AI‑powered natural language processing, machine learning, and agentic orchestration to analyze and improve inpatient care and support comprehensive quality, mortality, peer, and utilization reviews.

Jason Minor, EvaluCare Executive Director

Network Director Continuous Systems Improvement Jeffords Institute for Quality UVM Health

Board Chair Vermont Program for Quality in Health Care Inc.,

Vice Chair Northwestern Counseling & Support Services, Inc

Lecturer UVM College of Nursing & Health Sciences

Quality Peer Reviewer Vermont Care Partners: Centers of Excellence

References

1. HHS Office of Inspector General. Adverse Events in Hospitals: National Incidence among Medicare Beneficiaries. OEI-06-18-00400. November 2022. https://oig.hhs.gov/reports/2022/oei-06-18-00400.asp

2. Institute for Healthcare Improvement. IHI Global Trigger Tool for Measuring Adverse Events (Second Edition). IHI White Paper. https://www.ihi.org/resources/Pages/IHIWhitePapers/IHIGlobalTriggerToolWhitePaper.aspx

3. Classen DC, Resar R, Griffin F, et al. Global trigger tool shows that adverse events in hospitals may be ten times greater than previously measured. Health Affairs. 2011;30(4):555–563. doi:10.1377/hlthaff.2011.0190

4. National Academies of Sciences, Engineering, and Medicine. Improving Diagnosis in Health Care. National Academies Press. 2015. https://nap.edu/catalog/21794/improving-diagnosis-in-health-care

5. ECRI Guidelines Trust. A curated repository of clinical practice guidelines. https://guidelines.ecri.org

6. The Joint Commission. Comprehensive Accreditation Manual for Hospitals (CAMH). Updated annually. https://www.jointcommission.org

7. AHRQ. National Healthcare Quality and Disparities Report. https://www.ahrq.gov/research/findings/nhqrdr/index.html

8. NAHQ. Healthcare Quality Workforce Report. https://nahq.org/research/healthcare-quality-workforce-report

9. CMS. Hospital Value-Based Purchasing (HVBP) Program Overview. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/hospital-value-based-purchasing

10. CMS. Hospital Readmissions Reduction Program (HRRP). https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program

11. CMS. Hospital-Acquired Condition Reduction Program (HACRP). https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcutelnpatientPPS/HAC-Reduction-Program

12. CDC. Data Show US Hospitals Saw Continued Increases in Healthcare-Associated Infections in 2021. https://www.cdc.gov/hai/data/archive/2021-hai-increase.html

13. Weiner-Lastinger LM, Pattabiraman V, Konnor RY, et al. The impact of COVID-19 on healthcare-associated infections in 2020. Infection Control & Hospital Epidemiology. 2021;42(12):1409–1411. doi:10.1017/ice.2021.362

Notes: Program parameters vary by year; CAHs are exempt from certain Medicare quality programs. Consult current CMS program files and accreditation manuals for specifics. Eva supports quality and operations teams with timely information and workflows; outcomes depend on local context and implementation.