Can You Minimize Health Care Costs by Improving Patient Safety?

Session 2: How Can States and Institutions Work To Create a Culture of Safety?

Presentation by Marge Keyes

Via the World Wide Web and telephone, the second session of a Web-assisted audio teleconference series occurred on September 30, 2002. The User Liaison Program (ULP) of the Agency for Healthcare Research and Quality (AHRQ) developed and sponsored the program.

This is the text version of the slide presentation.

Slide 1

Image of Marge Keyes of AHRQ, Health Scientist Administrator, Center for Quality Improvement and Patient Safety.

Slide 2

Building the Business Case for Patient Safety—an AHRQ-Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Invitational Conference

• Architecture: more than just a financial argument.
• Foundation.
  • Defining and measuring Return on Investment (ROI).
  • Examining the impact of reimbursement and purchasing policies.
• Roughing in the structure.
• Raising the roof.
• Customizing the options.
• Passing inspection.

Slide 3

Evidence-based Practices to Improve Patient Safety

• Making Health Care Safer: A Critical Analysis of Patient Safety Practices (July 2001).
  • Patient safety practices: those that reduce the risk of AE related to exposure to medical care across a range of diagnoses or conditions.
  • 40 researchers (expertise in patient safety, EBM, and clinical medicine, nursing, and pharmacy).
  • Primarily hospital care but included some nursing home and ambulatory care practices.
  • Selection of practices relied on.
    • Inclusion criteria.
    • Structured evaluation of the evidence.

Slide 4

Top Evidence-based Safety Practices

• 11 of 79 practices rated highest.
  • Appropriate prophylaxis to prevent thromboembolism.
  • Perioperative beta-blockers.
  • Maximum sterile barriers when placing central IV catheters.
  • Antibiotic prophylaxis in surgical patients to prevent perioperative infection.
  • Antibiotic-impregnated central venous catheters to prevent catheter-related infections.
  • Continuous aspiration of subglottic secretions to prevent ventilator-associated pneumonia.

Slide 5

Top Evidence-based Safety Practices

• Pressure relieving bedding to prevent pressure ulcers.
• Real-time ultrasound guidance during central line insertion.
• Appropriate provision of nutrition (emphasis on early enteral nutrition for critically ill or surgical patients).
• Patient self-management for warfarin (Coumadin) to achieve appropriate outpatient anticoagulation and prevent complications.
• Patients to recall and restate informed consent information.

Slide 6

Response to the Evidence-based Practice Center (EPC) Report on Patient Safety Practices

• JAMA—July 24/31, 2002 Leape, Berwick, Bates.
  • Acceptance of a practice does not always rely on evidence from a randomized trial.
  • Reasonable judgment based on best "available" evidence may be acceptable approach.

Slide 7

Response to the EPC Report on Patient Safety Practices

• JAMA—July 24/31, 2002 Shojania, Duncan, McDonald, Wachter.
  • Charge was to identify evidence-based safety practices.
  • General insistence on evidence should not prevent implementation of practical, low-risk, understudied interventions that seem likely to work.

Slide 8

Response to the EPC Report on Patient Safety Practices

• Gap between standards considered acceptable by academics and standards of evidence considered acceptable by those in business.
• National Quality Forum (NQF) consensus development process.

Slide 9

Patient Safety Improvement Corps

• Goal: develop and maintain "front line" capacity for patient safety improvement at the community, regional, and State level.
• Objective: By 2004 have on-site experts and technical assistance in 10 States/health care organizations to improve patient safety.

Slide 10

Patient Safety Improvement Corps

• Initially considered two models.
  • CDC's EIS model.
  • Department of Agriculture cooperative State research, education, and extension service model.
• Feasibility study.
  • Diverse needs and opinions.

Slide 11

Patient Safety Improvement Corps

• Future users/participants.
  • American Hospital Association (AHA) representative conference calls.
  • NASHP State representative conference calls.
• Common needs.
  • Leadership buy-in.
  • Core content with short, practical courses.
  • Train together.

Slide 12

Criteria Used to Evaluate Evidence-Based Practices

• If I wanted to improve patient safety at my institution over next three years and resources were not a significant factor, how would I grade this practice?
• 4-person editorial board independently rated each of the 79 practices.
  • Find the best available evidence.
  • Three major categories for rating.

Slide 13

Clear Opportunities for Research

• Preventing infections.
  • Perioperative glucose control.
  • Use of supplemental perioperative oxygen.
  • Silver alloy coated urinary catheters.
  • Prophylactic antibiotics to prevent perioperative infection.
• Limited antibiotic use to prevent antibiotic resistance.
• Use of analgesics in patients with acute abdomen (without compromising diagnostic accuracy. Localizing surgery/procedures to high volume centers.
• Hand washing compliance.

Slide 14

Clear Opportunities for Research

• Appropriate enteral nutrition.
  • Post-surgical.
  • Critically ill.
• Appropriate use of prophylaxis to prevent venous thromboembolism in at-risk patients.
• Nurse staffing.
• Technology/Informatics.
  • CPOE with DSS to decrease medication errors and AE related to the drug ordering process.

Current as of March 2003

Internet Citation:

Text Version of Presentation by Marge Keyes. Can You Minimize Health Care Costs by Improving Patient Safety? Session 2: How Can States and Institutions Work To Create a Culture of Safety?. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/ulp/costsafetele/sess2/keyestxt.htm

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