Measuring patient safety is essential for healthcare, using methods like chart review, automated surveillance, voluntary error reporting, claims data review, and patient reports. While challenges persist, these strategies offer valuable insights. Chart review, considered the “gold standard,” examines medical records. Automated surveillance, including machine learning, can provide proactive insights. Voluntary error reporting systems rely on frontline staff but offer a passive form of surveillance. Claims data review is cost-effective but reactive. Patient reporting, although emerging, captures valuable data from patients and families about adverse events. Selecting the right tools is crucial for improving patient safety in healthcare.
Measuring patient safety is essential for ensuring a positive patient experience, but it requires specific methods to be effective. Without a tailored approach, improving patient safety becomes an elusive goal. As the saying goes, “You can’t improve what you don’t measure.” However, the measurement of patient safety is not a flawless science, according to the Agency for Healthcare Research and Quality (AHRQ). Many commonly used methods for assessing patient safety primarily offer a retrospective analysis, which ideally should be complemented by proactive strategies to prevent issues.
Moreover, not all aspects of patient safety are easily quantifiable; for instance, diagnostic errors remain challenging to reliably measure within the healthcare industry. Even when organizations can effectively measure patient safety issues, it can be difficult to determine whether an event was preventable or not.
Nevertheless, AHRQ outlines several strategies that healthcare organizations can employ. Patient safety assessment generally falls into two categories: the review of patient data and patient safety reporting. These include chart review, automated surveillance within Electronic Health Records (EHRs), patient safety event reporting, and patient reports of safety incidents.
Chart Review
Chart review is considered the “gold standard” for patient safety reporting and detection, as per AHRQ. During chart review, a thorough examination of medical records helps identify potential medical errors or patient safety events. In the past, healthcare organizations relied on clinicians to extract data from paper-based records. However, modern healthcare organizations have incorporated electronic triggers and automated tools that signal patient safety staff about adverse events, like the use of the anti-overdose drug naloxone, which may indicate an opioid overdose, a patient safety concern. While triggers still provide retrospective insights, they automate the process, reducing the time and cost of chart review. Various triggers are available, with the Global Trigger Tool from the Institute for Healthcare Improvement being one of the most widely used. Nevertheless, AHRQ and IHI caution against using triggers to determine preventability and highlight that their reliability depends on the individual reviewing the charts.
Prospective Automated Surveillance
Automated surveillance, including triggers, is a form of patient safety assessment. Triggers primarily provide a retrospective analysis, but researchers have explored using machine learning to proactively flag electronic records of patients at risk for adverse events before they occur. This proactive approach enables healthcare professionals to take preventive measures, although it may lead to some false positives.
Voluntary Error Reporting Systems
Voluntary error reporting systems play a foundational role in patient safety efforts within healthcare organizations. These systems allow individuals involved in patient care to report errors or incidents in detail, triggering a cascade of reporting to hospital or clinic management and patient safety teams. Effective voluntary error reporting systems rely on factors such as a supportive reporting environment, broad participation from personnel, timely dissemination of event summaries, and structured mechanisms for reviewing reports and developing action plans. These systems primarily rely on reports from frontline staff, including nurses, pharmacists, and physicians, but they offer a passive form of surveillance, primarily capturing near misses or unsafe conditions. Limitations include limited feedback on incident follow-up, overly lengthy reporting forms, perceptions that incidents are trivial, busyness inwards or departments, and confusion regarding reporting responsibility.
However, these systems can be valuable for delving into the processes contributing to or preventing adverse patient safety events. Organizations can encourage their use by demonstrating how they support patient safety improvements, promoting detailed reports for better investigation and quality improvement, and engaging physicians more actively in event reporting.
Administrative/Claims Data Review
Reviewing administrative and claims data offers a retrospective view of adverse patient safety events. Patient safety experts or algorithms can scan this data to identify such events, providing insights into patient safety rates and guiding quality improvement initiatives. This method is cost-effective and data-accessible, allowing experts to track safety events over time for population health analysis. However, it remains a reactive approach, and the accuracy of claims data may vary across healthcare systems.
Patient Reports
Patient reporting is an emerging field in patient safety detection, where patients and their families report adverse safety events to hospitals for investigation. This approach captures events that might otherwise go unnoticed by hospital staff, although tools for facilitating patient reporting are limited. Nonetheless, when hospitals make such tools available, the data can be valuable. For instance, a tool called MySafeCare facilitated patient-reported safety concerns anonymously and in real-time, uncovering critical insights despite a low submission rate. Patient and family involvement in reporting events is crucial since they often possess a complete view of the care journey surrounding an incident.
As healthcare organizations strive for zero harm, choosing the right systems and tools, from electronic chart review to patient and family engagement, will be pivotal in the journey toward quality improvement in patient safety.
