Patient safety interventions

The difficulty in assessing the effectiveness of patient safety interventions is the same as that for all programme evaluations it is difficult to find rigorous studies that measure programme effectiveness quantitatively. There have been a number of recent reviews of patient safety initiatives and their effectiveness. Morello et al. (2012) reviewed over 2,000 articles and found only 21 studies meeting their inclusion criteria for study rigour. They concluded that there is some evidence to support the theory that leadership walk rounds and multi-faceted unit-based programmes may have a positive impact on patient safety chmate. 

Many hospitals now use rapid response teams as a patient safety intervention. Patients whose condition deteriorates acutely while hospitalized often exhibit warning signs in the hours before experiencing adverse clinical outcomes. A 2006 consensus conference advocated use of the term rapid response system (RRS) as a unifying term. Many physician hospitalists now assume RRS duties, either as the primary responder or to assist nurse-led teams. Many hospitals permit any staff member to call the team if one of the following criteria is met (1) high or low heart rate, (2) high or... 

Demonstrate the ability to maintain patient safety during transport through splinting, immobilization, monitoring, and therapeutic interventions. 

This definition goes some way to differentiate patient safety from more general concerns about the quality of healthcare the focus is on the dark side of quality (Vincent, 1997), care that is actually harmful rather than just not of a good standard. Healthcare is, in many cases at least, inherently hazardous and the definition implicitly acknowledges this. The definition also refers to the amelioration of adverse outcomes or injuries, which broadens the definition beyond traditional safety concerns towards an area that would, in many industries, be called disaster management. In healthcare, amelioration firstly refers to the need for rapid medical intervention to deal with the immediate crisis, but also to the need to care for injured patients and to support the staff involved. 

Brown, C., Hofer, T., Johal, A. etal. (2008) An epistemology of patient safety research a framework for study design and interpretation. Part 1 Conceptualising and developing interventions. Quality and Safety in Health Care, 17(3), 158-162. 

Safety interventions coiiaboration between patients and professionais... 

The Hopkins team assumed from the outset that safety interventions could only take root if the front line staff were aware of the hazards patients faced and a need for change. A positive safety culture was regarded as essential, by no means sufficient to produce change but a necessary foundation. The safety critical attitudes, beliefs and behaviours need to be embedded at all levels of the organization, so that as far as possible everyone begins with a shared set of assumptions. 

The safety interventions are grounded in clinical practice and evidence based medicine. The goals are to deliver evidence based practice reliably and without harming patients. That is, of course, every clinician s goal however, as we have seen, the tricky part is making that happen. The approach has five key components (Pronovost, Berenholtz and Needham, 2008) ... 

As the success of this and related programmes became apparent, a much wider intervention was launched led by the Michigan Health and Hospital Keystone Association for Patient Safety and Quality. 108 Michigan ICUs took part in an 18-month intervention programme aimed particularly at decreasing catheter related bloodstream infections, a common, costly and potentially lethal complication of ICU care. In the United States, 80 000 patients each year were affected, with up to 28 000 deaths in intensive care units from this cause. 

Brown, C. and Lilford, R. (2008) Evaluating service delivery interventions to enhance patient safety. British Medical Journal, 338, 159-163. 

Chapter 9 Caring for patients harmed by treatment, 171 Chapter 10 Supporting staff after serious incidents, 192 SECTION FIVE Design, Technology and Standardization Chapter 11 Clinical interventions and process improvement, 211 Chapter 12 Design for patient safety, 230 Chapter 13 Using information technology to reduce error, 246... 

Evaluate the cultural impact of patient safety itutiatives and interventions... 

In the newest report, patient safety culture was included as one of the safe practices that were reviewed for its evidence, both as a practice and in terms of the context sensitivity of the practice and its adoption. In reviewing the evidence on patient safety culture as a practice. Weaver et al. (2013) suggest that developing a culture of safety is a core element of many efforts to improve patient safety and healthcare quality. Their systematic review identified and assessed interventions used to promote safety culture or climate in acute care settings. Based on this review the authors indicate that there is evidence suggesting that interventions can improve perceptions of safety culture and potentially reduce patient harm. 

Adams-Pizarro et al. (2008) Targeted culture intervention Across two years Hospitals participating in ED, ICU and OR collaboratives Hospital Survey on Patient Safety Culture OR teams improved on seven of 12 culture dimensions, ICU teams on three dimensions, and ED teams on one dimension... 

Adams-Pizarro, L, Walker, Z., Robinson, J., Kelly, S. and Toth, M. 2008. Using the AHRQ Hospital Survey on Patient Safety Culture as an intervention tool for regional clinical improvement collaboratives. Advances in Patient Safety New Directions and Alternative Approaches, 1-4. 

The strrveys of patient safely climate served Urriversity Hospital Zurich as a kind of roadmap to the futirre. Over the period between the comprehensive initial strrvey, conducted in 2006, and the most recerrt assessmerrt of patient safety chmate in an individual organisational rrrrit, these srrrveys have become a more or less standardised component of the hospital s qrralily management system. It has also been found that assessments of patient safety climate can be undertaken both at the level of individual teams in cormection with an intervention... 

Kim Lyngby Mikkelsen is a medical doctor with a PhD in public health epidemiology. He worked for 10 years as a senior researcher in occupational health safety research, focusing on safety culture and climate, on the development of a Nordic safety climate questionnaire and on safety intervention research. Since 2009 his work has been centred on patient safety, including learning from adverse events. 

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