Measuring hospital harm to improve patient care and optimize patient outcomes

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Patients expect hospital care to be safe, and for most people it is. However, a recent study showed that patients experienced potentially preventable harm in more than 138,000 hospitalizations or about  one in 18 hospitalizations (this does not include hospitalizations in Quebec).

Key findings from the Measuring Patient Harm in Canadian Hospitals report, which was released by the Canadian Institute for Health Information (CIHI) and the Canadian Patient Safety Institute (CPSI), showed that the five most common types of harm, making up 51 per cent of all harmful events, were electrolyte and fluid imbalance, urinary tract infections, delirium, anaemia-haemorrhage, and pneumonia.

It was estimated that patients who experienced harm spent a total of more than half a million additional days in hospital – that is more than 1,600 beds each day, or the equivalent of approximately four large hospitals occupied over a year. The associated hospital cost (excluding physician fees, follow-up care, and readmission) was about $685 million.

The Hospital Harm Measure identifies acute care hospitalizations with at least one occurrence of unintended harm (during the hospital stay) that could have potentially been prevented by implementing known evidence-informed practices. The measure is comprised of 31 clinical groups that fall under four categories.

The Hospital Harm measure complements other patient safety information available to hospitals, including patient safety incident reports, patient experience surveys, chart reviews or audits, infection control data, global trigger tools, and clinical quality improvement process measures. Combined, this information can inform and optimize improvement initiatives.

The Hospital Harm Improvement Resource was developed by the Canadian Patient Safety Institute to complement the CIHI Hospital Harm measure. It links measurement and improvement by providing evidence-informed practices that support patient safety improvement efforts.

The online Improvement Resource is a compilation of evidence-informed practices linked to each of the 31 clinical groups within the Hospital Harm measure to help drive changes that will make care safer. Through extensive research and consultation with clinicians, experts and leaders in quality improvement (QI) and patient safety, the Improvement Resource is intended to make information on improving patient safety easily available, so teams spend less time researching and more time optimizing patient care.

The Improvement Resource includes a summary of evidence-informed practices that reduce the likelihood of harm, and suggested measures for outcomes and processes. For example, evidence-informed practices for Delirium include: developing a standardized protocol for preventing or managing delirium, including identifying and treating underlying causes; implementing non-drug strategies such as early mobility; implementing environmental strategies such as visible daylight; and reassessing sedation daily. For Medication events the evidence includes: conducting an organizational Medication Safety Self-Assessment; implementing medication reconciliation and high-alert medication safety processes; and improving core processes for ordering, dispensing and administering medications. Also included in the resource are patient stories, success stories, standards and required organizational practices associated with each clinical group.

The Improvement Resource is a dynamic tool that the Canadian Patient Safety Institute will continue to update as new tools and approaches are developed and more evidence-informed practices emerge.

The hospital harm project aims to provide health system leaders with better information on patient safety and support patient safety improvement efforts. Armed with evidence-informed practices compiled through continued research efforts and united through collaboration, clinicians, hospital staff and patients can all play a role in improving safety in Canadian hospitals.

For more information, visit www.cihi.ca or www.patientsafetyinstitute.ca

This article was contributed by the Canadian Institute for Health Information and the Canadian Patient Safety Institute.