From the Departments of Pediatrics & Bioethics, Case Western Reserve University School of Medicine/UH Rainbow Babies & Children's Hospital, Cleveland.
James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital, Cincinnati, Ohio.
J Patient Saf. 2021 Dec 1;17(8):e1576-e1584. doi: 10.1097/PTS.0000000000000564.
Multihospital collaboration for safety improvements is increasingly common, but strategies for developing bundles when effective evidence-based practices are not well described are limited. The Children's Hospitals' Solutions for Patient Safety (SPS) Network sought to further reduce patient harm by developing improvement bundles when preliminary evidence was limited.
As part of the novel Pioneer process, cohorts of volunteer SPS hospitals collaborated to identify a harm reduction bundle for carefully selected hospital-acquired harm categories where evidence-based practices were limited. For each harm type, a leadership team selected interventions (factors) for testing and guided the work throughout the Pioneer process. Using fundamental quality improvement techniques and a planned experimentation design, each participating hospital submitted outcome and process compliance data for the factor implemented. Data from all hospitals implementing that factor were analyzed together using Shewhart charts, response plots, and analysis of covariance to identify whether reliable implementation of the factor influenced outcomes. Factors were categorized based on strength of evidence and other clinical or evidentiary support. Factors with strong support were included in a final bundle and disseminated to all SPS hospitals.
The SPS began the bundle identification process for nine harm types and three have completed the process. The analytic approach resulted in four scenarios that along with clinical input guided the inclusion or rejection of the factor in the final bundle.
In this multihospital collaborative, quality improvement methods and planned experimentation were effective at developing evidence-based harm reduction bundles in situations where limited data for interventions exist.
多医院合作以提高安全性的做法越来越常见，但在缺乏有效循证实践详细描述的情况下，制定捆绑包的策略有限。儿童医院患者安全解决方案（SPS）网络寻求通过制定改进捆绑包来进一步减少患者伤害，因为初步证据有限。
作为新颖的先锋过程的一部分，志愿者 SPS 医院的队列合作，为精心挑选的医院获得的危害类别确定减少伤害的捆绑包，这些危害类别缺乏循证实践。对于每种危害类型，一个领导团队选择要测试的干预措施（因素），并在整个先锋过程中指导工作。每个参与医院使用基本的质量改进技术和计划的实验设计，为实施的因素提交结果和过程合规数据。使用 Shewhart 图表、响应图和协方差分析，对所有实施该因素的医院的数据进行分析，以确定该因素的可靠实施是否影响结果。根据证据强度和其他临床或证据支持对因素进行分类。具有强有力证据的因素被纳入最终捆绑包，并分发给所有 SPS 医院。
SPS 开始了针对九种伤害类型和三种已经完成该过程的捆绑包识别过程。分析方法产生了四种情况，这些情况以及临床输入指导了因素在最终捆绑包中的纳入或拒绝。
在这种多医院合作中，质量改进方法和计划的实验在干预措施数据有限的情况下，有效地制定了基于证据的减少伤害捆绑包。
