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

doi:10.1016/j.jpeds.2013.06.031

The Journal of Pediatrics

Volume 163, Issue 6, December 2013, Pages 1638-1645

https://doi.org/10.1016/j.jpeds.2013.06.031 Get rights and content

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.

Section snippets

Methods

Nationwide Children's Hospital (NCH) is a large free-standing urban children's hospital with roughly 25 000 hospital admissions, 85 000 Emergency Department visits, 130 000 urgent care visits, and 22 000 operating room and ambulatory surgery center procedures in fiscal year 2012. Our effort began with the presentation of PHI data to the Quality of Care Committee of the hospital's Board of Directors. This created a sense of urgency, and culminated in a call to action from the Board to management

SSEs

A significant decrease in SSEs was seen after initiation of the Zero Hero program. The number of SSEs per quarter decreased by 85.1%, from 6.7 to 1.0 (P < .001). Subtracting the actual number of SSEs for each quarter from the baseline number of 6.7 per quarter, an estimated 63 SSEs were prevented over the past 11 quarters. The SSER decreased from a peak of 1.15 in November 2009 to 0.19 by March 2011, an 83.3% decrease (P < .001) (Figure 1). This rate reduction was sustained for 22 consecutive

Discussion

This study describes interventions and culture change strategies designed to reduce all identified preventable harm, using a global harm index as the primary outcome measure. Approximately 3 years after implementation of this patient safety program, we have obtained significant reductions in SSER, PHI, and hospital mortality; significant improvement in our hospital's safety climate; and decreased healthcare costs related to preventable harm by simultaneously implementing safety culture changes

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: The authors declare no conflicts of interest.

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

Objective

Study design

Results

Conclusion

Section snippets

Methods

SSEs

Discussion

Jt Comm J Qual Saf

Jt Comm J Qual Patient Saf

J Pediatr

Pediatr Clin North Am

To err is human: building a safer health system

Temporal trends in rates of patient harm resulting from medical care

N Engl J Med

Decreasing PICU catheter-associated bloodstream infections: NACHRI's quality transformation efforts

Pediatrics

The quality journey at Ascension Health: how we've prevented at least 1,500 avoidable deaths a year—and aim to do even better

Health Affairs

Journey to no preventable risk: the Baylor Health Care System patient safety experience

Am J Med Qual

Quality improvement initiative to reduce serious safety events and improve patient safety culture

Pediatrics

A safety culture transformation: its effects at a children's hospital

J Patient Saf

Managing the risks of organizational accidents

An NTSB for health care. Learning from innovation: debate and innovate or capitulate

J Patient Saf

The Safety Attitudes Questionnaire as a tool for benchmarking safety culture in the NICU

Arch Dis Child Fetal Neonatal Ed

Intensive care unit safety culture and outcomes: a US multicenter study

Int J Qual Health Care

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