A Comprehensive Patient Safety Program Can Significantly Reduce Preventable Harm, Associated Costs, and Hospital Mortality

• Published in: The Journal of pediatrics Vol. 163; no. 6; pp. 1638 - 1645
• Main Authors: Brilli, Richard J., MD, FAAP, FCCM, McClead, Richard E., MD, Crandall, Wallace V., MD, Stoverock, Linda, RN, MSN, NEA-BC, Berry, Janet C., RN, MBA, Wheeler, T. Arthur, MS, MSES, MBA, Davis, J. Terrance, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2013; Mosby, Inc
• Subjects: Child; climate; compliance; Cost Control; health services; Hospital Mortality; Hospitalization - economics; Hospitals, Pediatric; human resources; Humans; mortality; Patient Harm - prevention & control; Patient Safety - standards; patients; Pediatrics; Quality Improvement; Reproducibility of Results; teams; time series analysis; ADE; CLABSI; Quality improvement; SAQ; HRO; VAP; Nationwide Children's Hospital; PU; Pressure ulcer; IHI; High-reliability organization; Intensive care unit; PHI; Catheter-associated urinary tract infection; Preventable Harm Index; QI; Institute for Healthcare Improvement; CAUTI; Ventilator-associated pneumonia; SSE; Safety Attitudes Questionnaire; SSE rate; SSER; HAI; Hospital-acquired infection; NCH; Central line–associated bloodstream infection; Serious safety event; ICU; Adverse drug event
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2013.06.031

Objective To evaluate the effectiveness of a hospital-wide initiative to improve patient safety by implementing high-reliability practices as part of a quality improvement (QI) program aimed at reducing all preventable harm. Study design A hospital wide quasi-experimental time series QI initiative using high-reliability concepts, microsystem-based multidisciplinary teams, and QI science tools to reduce hospital acquired harm was implemented. Extensive error prevention training was provided for all employees. Change concepts were enacted using the Institute for Healthcare Improvement's Model for Improvement. Compliance with change packages was measured. Results Between 2010 and 2012, the serious safety event rate decreased from 1.15 events to 0.19 event per 10 000 adjusted hospital-days, an 83.3% reduction ( P  < .001). Preventable harm events decreased by 53%, from a quarterly peak of 150 in the first quarter of 2010 to 71 in the fourth quarter of 2012 ( P  < .01). Observed hospital mortality decreased from 1.0% to 0.75% ( P  < .001), although severity-adjusted expected mortality actually increased slightly, and estimated harm-related hospital costs decreased by 22.0%. Hospital-wide safety climate scores increased significantly. Conclusion Substantial reductions in serious safety event rate, preventable harm, hospital mortality, and cost were seen after implementation of our multifaceted approach. Measurable improvements in the safety culture were noted as well.