Journal Issue Highlights Patient Safety Strategies

BACKGROUND:
Over the past 12 years, since the publication of the Institute of Medicine's report "To Err is Human: Building a Safer Health System," improving patient safety has been the focus of considerable public and professional interest. For the past four years, a project team that includes HSR&D investigators and other academic researchers, along with an international panel of 21 stakeholders and evaluation methods experts, conducted an evidence-based assessment of patient safety strategies (PSSs). Part of this assessment was a review of current PSSs, which was narrowed to strategies that the project's expert panel judged to be the most important to the largest audience. Eighteen PSS topics were then chosen for in-depth review and 23 for brief review. All reviews can be found in the Agency for Healthcare Research and Quality (AHRQ) evidence report, "Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices." This Annals of Internal Medicine special supplement presents review results for 10 of the patient safety strategies. HSR&D investigator Dr. Paul Shekelle and colleagues also present an overview of the findings that includes: 1) Recommendations for evaluating the effectiveness of patient safety strategies, 2) High-priority contexts to include in reports of patient safety research, and 3) Patient safety strategies ready for adoption now.

SUMMARY FINDINGS:

Recommendations for Evaluating the Effectiveness of Patient Safety Strategies, such as:

• Describe the PSS in specific detail so it can be replicated
• Detail the implementation process, e.g., the actual effects on staff roles
• Assess the effect of patient safety practice on outcomes

High-priority Contexts to Include in Reports of Patient Safety Research, such as:

• External factors, e.g., regulatory requirements and public reporting
• Organization structure characteristics, e.g., size, complexity, and financial status or strength
• Management tools, e.g., training resources, internal organization incentives, audit and feedback, and quality improvement consultants

Patient Safety Strategies Ready for Adoption, such as:

• Preoperative checklists and anesthesia checklists to prevent operative and post-operative events
• Bundles that include checklists to prevent central-line associated bloodstream infections
• Interventions to reduce urinary catheter use, including catheter reminders, stop orders, or nurse-initiated removal protocols
• Hand hygiene
• Multi-component interventions to reduce pressure ulcers
• Barrier precautions to prevent health-care associated infections

Articles in this Special Supplement:

Shekelle P, Pronovost P, Wachter R, et al. The Top Patient Safety Strategies that Can Be Encouraged for Adoption Now. Annals of Internal Medicine March 5, 2013;158(5):

Wachter R, Pronovost P, and Shekelle P. Strategies to Improve Patient Safety: The Evidence Base Matures. Annals of Internal Medicine March 5, 2013;158(5):

McDonald K, Matesic B, Contopoulos-Ioannidis D, et al. Patient Safety Strategies Targeted at Diagnostic Errors. Annals of Internal Medicine March 5, 2013;158(5):

Reston J and Schoelles K. In-Facility Delirium Prevention Programs as a Patient Safety Strategy. Annals of Internal Medicine March 5, 2013;158(5):

Weaver S, Lubomksi L, Wilson R, et al. Promoting a Culture of Safety as a Patient Safety Strategy. Annals of Internal Medicine March 5, 2013;158(5):

Winters B, Weaver S, Pfoh E, et al. Rapid-Response Systems as a Patient Safety Practice. Annals of Internal Medicine March 5, 2013;158(5):

Miake-Lye I, Hempel S, Ganz D, and Shekelle P. Inpatient Fall Prevention Programs as a Patient Safety Strategy. Annals of Internal Medicine March 5, 2013;158(5):

Sullivan N and Schoelles K. Preventing In-Facility Pressure Ulcers as a Patient Safety Strategy. Annals of Internal Medicine March 5, 2013;158(5):

Schmidt E, Goldhaber-Fiebert S, Ho L, and McDonald K. Simulation Exercises as a Patient Safety Strategy. Annals of Internal Medicine March 5, 2013;158(5):

Rennke S, Nguyen O, Shoeb M, et al. Hospital-Initiated Transitional Care Interventions as a Patient Safety Strategy. Annals of Internal Medicine March 5, 2013;158(5):

Shekelle P. Nurse-Patient Ratios as a Patient Safety Practice. Annals of Internal Medicine March 5, 2013;158(5):

Kwan J, Lo L, Sampson M, and Shojania K. Medication Reconciliation During Transitions of Care as a Patient Safety Strategy. Annals of Internal Medicine March 5, 2013;158(5):

Annals of Internal Medicine March 5, 2013;158(5):