Association Between Hospital-Acquired Harm Outcomes and Membership in a National Patient Safety Collaborative

Abstract

networks supported by the US Centers for Medicare & Medicaid Services Partnership for Patients program have reported significant reductions in hospital-acquired harm, but methodological limitations and lack of peer review have led to persistent questions about the effectiveness of this approach.OBJECTIVE To evaluate associations between membership in Children's Hospitals' Solutions for Patient Safety (SPS), a federally funded hospital engagement network, and hospital-acquired harm using standardized definitions and secular trend adjustment. DESIGN, SETTING, AND PARTICIPANTSThis prospective hospital cohort study included 99 children's hospitals. Using interrupted time series analyses with staggered intervention introduction, immediate and postimplementation changes in hospital-acquired harm rates were analyzed, with adjustment for preexisting secular trends. Outcomes were further evaluated by early-adopting (n = 73) and late-adopting (n = 26) cohorts.EXPOSURES Hospitals implemented harm prevention bundles, reported outcomes and bundle compliance using standard definitions to the network monthly, participated in learning events, and implemented a broad safety culture program. Hospitals received regular reports on their comparative performance. MAIN OUTCOMES AND MEASURESOutcomes for 8 hospital-acquired conditions were evaluated over 1 year before and 3 years after intervention. RESULTSIn total, 99 hospitals met the inclusion criteria and were included in the analysis. A total of 73 were considered part of the early-adopting cohort (joined between 2012-2013) and 26 were considered part of the late-adopting cohort (joined between 2014-2016). A total of 42 hospitals were freestanding children's hospitals, and 57 were children's hospitals within hospital or health systems. The implementation of SPS was associated with an improvement in hospital-acquired condition rates in 3 of the 8 conditions after accounting for secular trends. Membership in the SPS was associated with an immediate reduction in central catheter-associated bloodstream infections (coefficient = −0.152; 95% CI, −0.213 to −0.019) and falls of moderate or greater severity (coefficient = −0.331; 95% CI, −0.594 to −0.069). The implementation of the SPS was associated with a reduction in the monthly rate of adverse drug events (coefficient = −0.021; 95% CI, −0.034 to −0.008) in the post-SPS period. The study team observed larger decreases for the early-adopting cohort compared with the late-adopting cohort.CONCLUSIONS AND RELEVANCE Through the application of rigorous methods (standard definitions and longitudinal time series analysis with adjustment for secular trends), this study provides a more thorough analysis of the association between the Partnership for Patients hospital engagement network model and reductions in hospital-acquired conditions. These findings strengthen previous claims of an association between this model and improvement. However, inconsistent observations across hospital-acquired conditions when adjusted for secular trends suggests that...

Quality and safety in the literature: January 2023

“…In this context, Coffey and colleagues aimed to evaluate the association between membership in Children’s Hospitals’ Solutions for Patient Safety (SPS), a hospital engagement network comprised of hospital partners in the USA and Canada, and hospital-acquired harm using standardised definitions and secular trend adjustment 19. Their prospective cohort study with historical controls harnessed interrupted time series analyses with staggered intervention introduction.…”

Pediatric Patient Safety—First Steps Forward

“…It is only through hard work to develop new processes of care coupled with efforts to implement changes and bake those changes into the culture of health care that we will continue to move forward. The study by Coffey et al shows that forward movement is possible. Let us all build off of the hope this finding brings and reinvigorate our efforts to truly get to zero harm.…”

“…First, it is important to recognize that while not all of the reductions seen are clearly causally attributable to the HEN intervention, the finding of improvement over time in 7 of 8 patient safety measures, regardless of cause, is remarkable. While some prior studies have suggested improvements after many years of hard work in adverse event rates for certain discrete conditions, hospital-wide rates of harms both in hospitals generally and in pediatric hospitals in particular appeared not to be improving in the years before the study by Coffey et al While the 8 serious safety events (SSEs) the authors followed are not a representative sample of all harms, they are some of the highest profile harms in hospitals and have been the focus of major patient safety improvement efforts. It is extremely encouraging to see data suggesting that work beginning to pay off, whether this is the result of the SPS’s work alone or the combined effect of the SPS plus one or more of the many concurrent, widespread efforts to improve safety, including high-reliability health care initiatives, reductions in resident-physician extended work shifts, changes in nurse workloads, or efforts to improve handoffs and communication on family-centered rounds, to name just a few.…”

“…In the current issue of JAMA Pediatrics, Coffey and colleagues 8 report on the success of a particular implementation mechanism, the Hospital Engagement Network (HEN) model. The Solutions for Patient Safety (SPS) HEN is a collaboration of children's hospitals and other organizations that care for children from across the US whose stated goal is to eliminate harm due to medical care.…”

“…SPS convened working groups of clinical content and quality improvement experts who developed or adapted a series of patient safety bundles—collections of complementary, evidence-based interventions—and aided member hospitals in their implementation. In 99 SPS hospitals, Coffey et al found in rigorous interrupted time series analyses that adverse drug events, CLABSIs, and falls were significantly reduced after introduction of the SPS bundles. Additionally, while not clearly tied temporally to the SPS HEN intervention itself, they observed significant improvements over time in 4 other hospital-acquired conditions: catheter-associated urinary tract infection, pressure injuries, surgical site infections, and ventilator associated pneumonia.…”