Do Emergency Transfers Reflect Hospital Quality? Preventable Harm and the Next 100 000 Lives.

Consider these actual patient experiences: Despite being simultaneously dreadful and familiar to healthcare professionals,1 cases like these are not systematically identified or addressed in hospital quality improvement programmes.2 As a...

PurposeThe purpose of this paper is to provide a practical framework that health care organizations could use to decrease preventable healthcare-acquired harms.Design/methodology/approachAn existing theory of how hospitals succeeded in reducing rates of central line-associated bloodstream infections was refined, drawing from the literature and experiences in facilitating improvement efforts in thousands of hospitals in and outside the USA.FindingsThe following common interventions were implemented by hospitals able to reduce and sustain low infection rates. Hospital and intensive care unit (ICU) leaders demonstrated and vocalized their commitment to the goal of zero preventable harm. Also, leaders created an enabling infrastructure in the way of a coordinating team to support the improvement work to prevent infections. The team of hospital quality improvement and infection prevention staff provided project management, analytics, improvement science support, and expertise on evidence-based infection prevention practices. A third intervention assembled Comprehensive Unit-based Safety Program teams in ICUs to foster local ownership of the improvement work. The coordinating team also linked unit-based safety teams in and across hospital organizations to form clinical communities to share information and disseminate effective solutions.Practical implicationsThis framework is a feasible approach to drive local efforts to reduce bloodstream infections and other preventable healthcare-acquired harms.Originality/valueImplementing this framework could decrease the significant morbidity, mortality, and costs associated with preventable harms.

BackgroundThe Standardized Infection Ratio (SIR) is a metric used to gauge catheter-associated urinary tract infection (CAUTI) prevention, both locally and nationally. The device utilization ratio (DUR) is a process metric that captures catheter harm. More recently, the cumulative attributable difference (CAD) was introduced, which identifies the number of excess infections that need to be prevented to reach the desired goal. Our objective was to evaluate these metrics across all acute care hospitals in Connecticut (CT) by facility size.MethodsA CAUTI Targeted Assessment for Prevention (TAP) Report for acute care hospitals across CT was generated from 1/1/2018 to December 31/2018, using the National Healthcare Safety Network (NHSN) database. CAUTI events, SIR, DUR, and CAD were compared across all hospitals. The SIR goal of 0.75 was used to calculate the CAD. Hospitals were stratified into large ( >425 beds), medium (250 to 424 beds), and small ( <249 beds) based on the Healthcare Cost and Utilization Project NIS Description of Data Elements, Agency for Healthcare Research and Quality for urban hospitals in the northeast region.ResultsA comparison of CAUTI metrics for 29 acute care hospitals across CT is shown in Table 1. Median SIR and DUR were 0.97, 1.02, 0.77, and 22%, 14%, 14.5% for large, medium and small hospitals, respectively. Of the 20 small hospitals, SIR could not be calculated for 5 hospitals, while 2 hospitals had an SIR = 0, as they had no reported infections. Median CAD for large, medium and small hospitals was 6.17, 1.3 and 0.25, respectively. Of note, 40% of small hospitals (J – CC, as in Table 1) had a negative CAD. Interestingly, 5 of these 8 hospitals with a negative CAD had a DUR higher than 16%.ConclusionBased on CT hospital data, metrics like CAD and SIR may be more suitable for larger hospitals or hospitals with higher CAUTI events, whereas DUR may be a more useful metric for smaller hospitals or hospitals with rare events. Hospitals with high SIR and low DUR may represent a population with high-risk catheter use, poor catheter care or higher rates of urine culturing. On the other hand, hospitals with high DUR and low SIR may represent low-risk populations, better catheter care practices or lower rates of urine culturing. Ultimately, we need a combination of metrics to measure preventable catheter harm.DisclosuresLouise Dembry, MD, MS, MBA, ReadyDock: Consultant, Stock options.

The delivery of high-quality healthcare services is a multifaceted endeavor influenced by various factors, among which human factors play a pivotal role. This paper explores the significance of human factors in upholding service quality within hospital settings. Drawing upon interdisciplinary research from fields such as psychology, sociology, and healthcare management, it examines the intricate interplay between healthcare professionals, patients, and organizational structures. In today's healthcare landscape, where patient-centric care is increasingly emphasized, understanding the impact of human factors is paramount. One of the primary focuses is on patient satisfaction, which is not only influenced by clinical outcomes but also by the quality of interactions with healthcare providers. Effective communication between healthcare professionals and patients is essential for building trust, managing expectations, and ensuring informed decision-making. Moreover, the demeanor, empathy, and interpersonal skills of healthcare staff significantly contribute to patients' overall experience and satisfaction levels. Safety is another critical aspect of service quality in hospitals, and human factors play a central role in patient safety initiatives. Research has shown that the majority of adverse events in healthcare are attributable to human error, highlighting the importance of addressing factors such as fatigue, stress, and workload among healthcare professionals. Furthermore, teamwork and collaboration are vital for promoting a culture of safety, where healthcare providers work together cohesively to identify and mitigate risks, thereby enhancing patient outcomes and reducing preventable harm. Effective leadership within healthcare organizations is also instrumental in shaping service quality. Strong leadership sets the tone for organizational culture, values, and priorities, influencing the behavior and performance of healthcare staff. Leaders who prioritize patient-centered care, employee well-being, and continuous quality improvement foster an environment conducive to delivering high-quality services. To optimize service quality, hospitals must invest in staff training, development, and support programs. Ongoing education ensures that healthcare professionals stay abreast of the latest evidence-based practices, technological advancements, and regulatory requirements. Moreover, initiatives to promote staff well-being, such as employee assistance programs, work-life balance initiatives, and resilience training, are essential for preventing burnout and maintaining morale. In conclusion, human factors play a multifaceted role in maintaining service quality in hospitals, encompassing aspects such as communication, teamwork, leadership, and staff well-being. By recognizing the complexities of human interactions within healthcare systems and implementing targeted interventions, hospitals can enhance service delivery, improve patient outcomes, and cultivate a culture of excellence.

“Patient safety is a core attitude and thus needs to be introduced early and then reinforced throughout postgraduate education and continuing professional development.” (Stefan Lindgren, President of the World Federation for Medical Education) Beginning in the 1990s, studies of hospital safety and quality from around the world have consistently found problems with patient safety and quality [1]. There has been a notable increase in awareness of the problem, with major efforts in the past two decades to improve the safety of medical care. A study conducted for the World Health Organization found that seven types of adverse events cause 43 million injuries a year, making preventable harm the world’s twentieth most common cause of overall morbidity and mortality [2]. Others have suggested that medical errors are even more common [3]. A chilling statistic from WHO was that in high income countries, on average, one of every ten patients hospitalized suffers a serious, preventable adverse event [4]. Although patients continue to be harmed by health care, there has been some progress [5]. Since 2000, it has become widely understood and accepted that “it’s the system” – it is the health care system that creates hazards and harm, and that also creates patient safety, rather than individual providers [6]. However, there is a deeply seated, pernicious habit for people, the public and health care managers to blame specific medical errors exclusively on individual health professionals. On the other hand, it is certainly true that individuals are an integral and indispensable component of the health care system. Individuals also act as members of teams, and interact with other parts of the system [7]. Individual must feel they are accountable too. If the balance of accountability swings too far, and we rely entirely on searching for systems solutions, the important process of changing individual behaviors will be lost [8]. Regardless of whether you take an individual or system perspective on the causation of medical error, there is a need to educate clinicians on how to deliver safer care. We believe that patient safety should be a new basic science for professional education. To accomplish this, major reforms are needed in health professions education. However, we appreciate that there are challenges associated with incorporating patient safety into education and training. This special issue on patient safety in medical education in Germany represents an important step to increasing awareness of patient safety as an important element in the training of health professionals. The papers in this issue help to advance the field, in both education and in research on education.