Are Patient Safety Indicators Related to Widely Used Measures of Hospital Quality?

Isaac, Thomas; Jha, Ashish K.

doi:10.1007/s11606-008-0665-2

Cited by 45 publications

(26 citation statements)

References 15 publications

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“…On the other hand, there is still limited evidence on a quantitative relationship between safety culture and outcomes measures of safety that apply to the entire hospital 20 21. Therefore, future research is needed to understand how improvement strategies influence patient safety culture and how safety culture assessment can be related to outcome measurement.…”

Section: Discussionmentioning

confidence: 99%

A nationwide Hospital Survey on Patient Safety Culture in Belgian hospitals: setting priorities at the launch of a 5-year patient safety plan

et al. 2012

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The nationwide safety culture assessment confirms the need for a long-term national initiative to improve patient safety culture and provides each hospital with a baseline patient safety culture profile to direct an intervention plan. The identification of clusters of safety culture dimensions indicates the need for a different approach and context towards the implementation of interventions aimed at improving the safety culture. Certain clusters require unit level improvements, whereas others demand a hospital-wide policy.

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Section: Discussionmentioning

confidence: 99%

A nationwide Hospital Survey on Patient Safety Culture in Belgian hospitals: setting priorities at the launch of a 5-year patient safety plan

et al. 2012

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“…Also, because of the generally more vulnerable status of ICU patients, any care-related omissions that lead to EK reflect potential opportunities for improvement in overall care quality. Therefore, the incidence of EK should be considered as either direct or indirect PS indicator [9,34]. Optimally, surveillance and prevention efforts aimed at EK should be incorporated into evidence-based nursing practice, where awareness of the problem is coupled with appropriate education that helps facilitate around-the-clock attention to the specific PS issue [9,35].…”

Section: Exposure Keratopathy: Pathophysiology Diagnosis Symptomsmentioning

confidence: 99%

Exposure Keratopathy in the Intensive Care Unit: Do Not Neglect the Unseen

Bird¹,

Dingley²,

Stawicki³

et al. 2018

Vignettes in Patient Safety - Volume 2

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Exposure keratopathy (EK) is a frequently overlooked complication seen in nearly 60% of sedated or intubated intensive care unit (ICU) patients. Signs and symptoms of EK often start as mild subjective complaints of eye pain and irritation, but can progress to vision loss in the most severe cases. For many critically ill patients, the presence of sedation effectively precludes their ability to communicate clinical complaints typically associated with EK. This, combined with the potentially severe sequelae, makes EK a potentially preventable complication and a patient safety issue. Clinical management of EK can be challenging for both providers and patients due to the nature of treatment with eye drops and ointments as well as the burden and expense of associated procedural interventions. Risk factors for EK have been extensively described in the literature, and wider dissemination of this knowledge should facilitate education of physicians and nurses regarding EK prevention. The most common risk factors include lagophthalmos, chemosis, Bell's palsy, and congenital deformities. Additionally, critically ill patients are less likely to be promptly diagnosed due to the focus of staff on life-threatening problems over ocular prophylaxis. However, the potential severity of complications associated with EK mandates that prevention remains a crucial component of the care of at-risk patients. The reader will explore the broad category of adverse medical occurrences included under the umbrella term, "errors of omission" (EOO): an error category that is most likely to culminate in EK. The most critical preventive measure is education of health care providers, although this may not be enough by itself. To this end, universal precautions against EK in combination with education may be used to help combat the relatively high incidence of this easily preventable ocular pathology.

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“…However, the extent as well as magnitude of associations among quality indicators at the hospital level is an empirical question. For example, Issac and Jha 16 found "inconsistent and usually poor associations" between various hospital-level safety indicators and other quality-of-care indicators. Thus, some hospitals providing excellent PM-specified care to high percentages of patients with a specific condition may have poor quality in other domains that affect their patients' outcomes, leading to null or weak relationships with outcomes in hospital-level analyses.…”

Section: Why Relationships Can Differ At the Patient And Hospital Levelsmentioning

confidence: 99%

Excellent Patient Care Processes in Poor Hospitals? Why Hospital-Level and Patient-Level Care Quality-Outcome Relationships Can Differ

et al. 2016

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Studies finding weak or nonexistent relationships between hospital performance on providing recommended care and hospital-level clinical outcomes raise questions about the value and validity of process of care performance measures. Such findings may cause clinicians to question the effectiveness of the care process presumably captured by the performance measure. However, one cannot infer from hospital-level results whether patients who received the specified care had comparable, worse or superior outcomes relative to patients not receiving that care. To make such an inference has been labeled the "ecological fallacy," an error that is well known among epidemiologists and sociologists, but less so among health care researchers and policy makers. We discuss such inappropriate inferences in the health care performance measurement field and illustrate how and why process measure-outcome relationships can differ at the patient and hospital levels. We also offer recommendations for appropriate multilevel analyses to evaluate process measure-outcome relationships at the patient and hospital levels and for a more effective role for performance measure bodies and research funding organizations in encouraging such multilevel analyses.

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Are Patient Safety Indicators Related to Widely Used Measures of Hospital Quality?

Cited by 45 publications

References 15 publications

A nationwide Hospital Survey on Patient Safety Culture in Belgian hospitals: setting priorities at the launch of a 5-year patient safety plan

A nationwide Hospital Survey on Patient Safety Culture in Belgian hospitals: setting priorities at the launch of a 5-year patient safety plan

Exposure Keratopathy in the Intensive Care Unit: Do Not Neglect the Unseen

Excellent Patient Care Processes in Poor Hospitals? Why Hospital-Level and Patient-Level Care Quality-Outcome Relationships Can Differ

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