How will we know patients are safer? An organization-wide approach to measuring and improving safety

Peter Pronovost, Christine G. Holzmueller, Dale M. Needham, J. Bryan Sexton, Marlene Miller, Sean Berenholtz, Albert W. Wu, Trish M. Perl, Richard Davis, David Baker, Laura Winner, Laura Morlock

Research output: Contribution to journalShort survey

64 Citations (Scopus)

Abstract

OBJECTIVE: Our institution, like many, is struggling to develop measures that answer the question, How do we know we are safer? Our objectives are to present a framework to evaluate performance in patient safety and describe how we applied this model in intensive care units. DESIGN: We focus on measures of safety rather than broader measures of quality. The measures will allow health care organizations to evaluate whether they are safer now than in the past by answering the following questions: How often do we harm patients? How often do patients receive the appropriate interventions? How do we know we learned from defects? How well have we created a culture of safety? The first two measures are rate based, whereas the latter two are qualitative. To improve care within institutions, caregivers must be engaged, must participate in the selection and development of measures, and must receive feedback regarding their performance. The following attributes should be considered when evaluating potential safety measures: Measures must be important to the organization, must be valid (represent what they intend to measure), must be reliable (produce similar results when used repeatedly), must be feasible (affordable to collect data), must be usable for the people expected to employ the data to improve safety, and must have universal applicability within the entire institution. SETTING: Health care institutions. RESULTS: Health care currently lacks a robust safety score card. We developed four aggregate measures of patient safety and present how we applied them to intensive care units in an academic medical center. The same measures are being applied to nearly 200 intensive care units as part of ongoing collaborative projects. The measures include how often do we harm patients, how often do we do what we should (i.e., use evidence-based medicine), how do we know we learned from mistakes, and how well do we improve culture. Measures collected by different departments can then be aggregated to provide a hospital level safety score card. CONCLUSION: The science of measuring patient safety is immature. This article is a starting point for developing feasible and scientifically sound approaches to measure safety within an institution. Institutions will need to find a balance between measures that are scientifically sound, affordable, usable, and easily applied across the institution.

Original languageEnglish (US)
Pages (from-to)1988-1995
Number of pages8
JournalCritical Care Medicine
Volume34
Issue number7
DOIs
StatePublished - Jul 1 2006

Fingerprint

Organizations
Safety
Patient Safety
Patient Harm
Intensive Care Units
Delivery of Health Care
Safety Management
Evidence-Based Medicine
Caregivers

Keywords

  • Measures
  • Quality measurement
  • Quality of care
  • Safety

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Pronovost, P., Holzmueller, C. G., Needham, D. M., Sexton, J. B., Miller, M., Berenholtz, S., ... Morlock, L. (2006). How will we know patients are safer? An organization-wide approach to measuring and improving safety. Critical Care Medicine, 34(7), 1988-1995. https://doi.org/10.1097/01.CCM.0000226412.12612.B6

How will we know patients are safer? An organization-wide approach to measuring and improving safety. / Pronovost, Peter; Holzmueller, Christine G.; Needham, Dale M.; Sexton, J. Bryan; Miller, Marlene; Berenholtz, Sean; Wu, Albert W.; Perl, Trish M.; Davis, Richard; Baker, David; Winner, Laura; Morlock, Laura.

In: Critical Care Medicine, Vol. 34, No. 7, 01.07.2006, p. 1988-1995.

Research output: Contribution to journalShort survey

Pronovost, P, Holzmueller, CG, Needham, DM, Sexton, JB, Miller, M, Berenholtz, S, Wu, AW, Perl, TM, Davis, R, Baker, D, Winner, L & Morlock, L 2006, 'How will we know patients are safer? An organization-wide approach to measuring and improving safety', Critical Care Medicine, vol. 34, no. 7, pp. 1988-1995. https://doi.org/10.1097/01.CCM.0000226412.12612.B6
Pronovost, Peter ; Holzmueller, Christine G. ; Needham, Dale M. ; Sexton, J. Bryan ; Miller, Marlene ; Berenholtz, Sean ; Wu, Albert W. ; Perl, Trish M. ; Davis, Richard ; Baker, David ; Winner, Laura ; Morlock, Laura. / How will we know patients are safer? An organization-wide approach to measuring and improving safety. In: Critical Care Medicine. 2006 ; Vol. 34, No. 7. pp. 1988-1995.
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