Safety practice guidelines have no effect on hospital mortality, infections
MedWire News: Compliance with National Quality Forum (NQF) patient safety practices does not lower hospital mortality or hospital-associated infection (HAI) rates in the USA, report researchers.
Variability of trauma center outcomes in the USA presents an opportunity to explore associations between specific processes of care and their outcomes, explain the researchers, who found that compliance with the Leapfrog Group's Safe Practices for Better Healthcare strategy had no visible effect on inpatient death or infection incidence.
"With the release of the highly publicized Institute of Medicine report describing safety problems in US hospitals, the public has lost some of its confidence in the ability of organized medicine to regulate itself and to ensure high quality of care," say Laurent Glance (University of Rochester School of Medicine, New York) and colleagues.
However, their negative finding does not mean that adherence to NQF safety practices does not result in improved outcomes, they add, in the Archives of Surgery. Indeed, it is possible that self-reported measures of hospital adherence to the practices may not adequately capture real-life clinical practice.
Using data from the 2006 Healthcare Cost and Utilization Project Nationwide Inpatient Sample, the team examined associations between trauma outcomes and the composite score on the Safe Practices Survey (SPS) among 42,417 patients at 58 hospitals.
Most patients were male (59.1%) and the most frequent causes of injury were blunt trauma (47.5%), low falls (18.2%), and motor vehicle accidents (17.2%).
Analysis adjusted for potentially confounding patient- and hospital-level confounders showed that total score on the SPS was not associated with either mortality (adjusted odds ratio [AOR]=0.92) or HAI (AOR=1.03).
Computerized physician order entry (CPOE) and intensive staffing of intensive care units (ICUs) - the two patient safety practices not covered by the SPS - were also unassociated with clinical outcome. Full implementation of either strategy had no effect on mortality or HAI rates, remark Glance and co-investigators.
One patient safety practice covered by the SPS predicted lower mortality rates, however. Disclosure of adverse events, defined as informing patients and families of systems failure or human errors leading to unanticipated outcomes, was associated with a 13% lower mortality compared with nondisclosure.
Glance et al suggest that the real value of performance measurement is to create an opportunity to transform hospitals into "learning laboratories," so that "true" best practices can be identified and used to improve quality of care.
They add that consideration should be given to adding the most relevant trauma patient safety practices to the American College of Surgeons Trauma Quality Improvement Program, so that more accurate NQF compliance could be measured.
This could help highlight best practices for trauma care and "improve patient outcomes in trauma centers," they conclude.
By Sarah Guy