From the Department of Anesthesia, National University Hospital Singapore.
Medical Affairs, Clinical Governance Department, National University Hospital Singapore.
J Patient Saf. 2022 Jan 1;18(1):e189-e195. doi: 10.1097/PTS.0000000000000725.
Adverse events (AEs) remain a challenge in tertiary healthcare with incidence rates of 4% to 14%, where half are potentially preventable. Reported patient safety strategies rarely involve changing the practices of an entire academic institution and maintaining sustainability. We hypothesize that implementing an effective patient safety strategy (PSS) improves hospital-wide AE rates, cost avoidance, and patient safety culture.
A 3-stage hospital-wide PSS was implemented from 2012 to 2016, involving a top-down, bottom-up approach in a 1171-bed academic institution. The primary outcome was the incidence, preventability, and severity of hospital-wide AEs, calculated through the Institute of Healthcare Improvement, Global Trigger Tool method (incidence), National Coordinating Council for Medication Error Reporting and Prevention tool (severity), and a preventability decision algorithm (preventability). Secondary outcomes include hospital-wide cost savings and patient safety climate survey results.
A total of 15,120 random chart reviews were performed across 430,868 admissions from 2012 to 2018. Overall, AE rates decreased from 11.6% to 5.4% (R2 = 0.71, P = 0.017). The incidence of preventable AEs declined from 5.7% to 2.0% (R2 = 0.80, P = 0.006). The severity of AEs reduced, with the proportion of category G, H, and I AEs decreasing from 8.4% (2012) to 2.6% (2018). A total of 15,960 hospital-wide patient safety climate surveys were administered from 2011 to 2016, demonstrating an improvement in hospital-wide percentage positive patient safety grade from 46.5% pre-PSS to 58.3% post-PSS implementation. This was accompanied by an 82% increase in voluntary event reporting, and cost savings of 20,600 bed-days and U.S. $29.2 million upon completion of stage 3 (2012-2016).
The hospital-wide PSS resulted in significant improvements in the incidence and severity of AEs, healthcare cost savings, and patient safety culture, demonstrating sustainability for 7 years.
不良事件（AE）仍然是三级医疗保健的一个挑战，其发生率为 4%至 14%，其中一半是潜在可预防的。报告的患者安全策略很少涉及改变整个学术机构的实践并保持可持续性。我们假设实施有效的患者安全策略（PSS）可以提高医院范围内的 AE 发生率、成本节约和患者安全文化。
从 2012 年到 2016 年，在一家拥有 1171 张床位的学术机构中，实施了分三个阶段的全院范围的 PSS，涉及自上而下和自下而上的方法。主要结局是通过医疗保健改善研究所全球触发工具方法（发生率）、国家协调委员会药物错误报告和预防工具（严重程度）和预防决策算法（预防）计算的医院范围内 AE 的发生率、可预防程度和严重程度。次要结局包括医院范围内的成本节约和患者安全气候调查结果。
在 2012 年至 2018 年期间，对 430868 次住院患者进行了 15120 次随机图表审查。总体而言，AE 发生率从 11.6%降至 5.4%（R2 = 0.71，P = 0.017）。可预防 AE 的发生率从 5.7%降至 2.0%（R2 = 0.80，P = 0.006）。AE 的严重程度降低，类别 G、H 和 I AE 的比例从 8.4%（2012 年）降至 2.6%（2018 年）。从 2011 年到 2016 年，共进行了 15960 次全院患者安全气候调查，表明在实施 PSS 前的 46.5%，到实施后的 58.3%，全院患者安全等级的正百分比有所提高。这伴随着自愿事件报告增加了 82%，以及在第 3 阶段（2012-2016 年）完成后，节省了 20600 个床位日和 2920 万美元的医疗成本。
全院范围的 PSS 显著改善了 AE 的发生率和严重程度、医疗保健成本节约和患者安全文化，证明了其 7 年的可持续性。
