Abstract
BackgroundCare pathways can be complex, often involving multiple care providers and as such are recognised as containing multiple opportunities for error. Prospective hazard analysis methods may be useful for evaluating care provided across primary and secondary care pathway boundaries. These methods take into account the views of users (staff and patients) when determining where potential hazards may lie. The aim of this study is to evaluate the feasibility of prospective hazard analysis methods when assessing quality and safety in care pathways that lie across primary and secondary care boundaries.MethodsDevelopment of a process map of the care pathway for patients entering into a Chronic Obstructive Pulmonary Disease (COPD) supported discharge programme. Triangulation of information from: care process mapping, semi-structured interviews with COPD patients, semi-structured interviews with COPD staff, two round modified Delphi study and review of prioritised quality and safety challenges by health care staff.ResultsInterview themes emerged under the headings of quality of care and patient safety. Quality and safety concerns were mostly raised in relation to communication, for example, communication with other hospital teams. The three highest ranked safety concerns from the modified Delphi review were: difficulties in accessing hospital records, information transfer to primary care and failure to communicate medication changes to primary care.ConclusionThis study has demonstrated the feasibility of using mixed methods to review the quality and safety of care in a care pathway. By using multiple research methods it was possible to get a clear picture of service quality variations and also to demonstrate which points in the care pathway had real potential for patient safety incidents or system failures to occur. By using these methods to analyse one condition specific care pathway it was possible to uncover a number of hospital level problems. A number of safety challenges were systems related; these were therefore difficult to improve at care team level. Study results were used by National Health Service (NHS) stakeholders to implement solutions to problems identified in the review.
Highlights
Care pathways can be complex, often involving multiple care providers and as such are recognised as containing multiple opportunities for error
Rea-This paper reports the feasibility of using mixed methods to inform a prospective hazard analysis of the risks in a care pathway, in the context of applying the methods to a prospective hazard analysis of a Chronic Obstructive Pulmonary Disease (COPD) supported discharge care pathway
By triangulating information from a detailed mapping of the care pathway, from views and from concerns of users, and by ranking problems by potential severity of impact on care quality and patient safety, it was possible for health care staff to get a clear picture of service quality variations in the supported discharge programme
Summary
Care pathways can be complex, often involving multiple care providers and as such are recognised as containing multiple opportunities for error. A more limited literature relates to health care [2] where adapted methods such as Health Care Failure Modes and Effects Analysis [3] have been used to assess risks in high risk systems such as blood transfusion [4] Other methods, such as socio-technical probabilistic risk analysis [5], are being used in aspects of medication safety or have been used in the study of complex environments such as anaesthesia [6]. Where they have been used in health care, most of these risk analyses have taken place in hospital-based settings, focussing on well-defined care processes. Care pathways that cross the boundary between community and hospital care are recognised to contain opportunities for error, both latent and active [7]
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