Assessing the impact of real-time random safety audits through full propensity score matching on reliable data from the clinical information system

• Published in: International journal of medical informatics (Shannon, Ireland) Ireland), 2024-04, Vol.184, p.105352-105352, Article 105352
• Main Authors: Bodí, Maria, Samper, Manuel A., Sirgo, Gonzalo, Esteban, Federico, Canadell, Laura, Berrueta, Julen, Gómez, Josep, Rodríguez, Alejandro
• Format: Article
• Language: English
• Subjects: Clinical Information System; Critical patients; Intensive care unit; Patient Safety; Quality indicators; Real world data; Real-time safety audits
• ISSN: 1386-5056; 1872-8243
• DOI: 10.1016/j.ijmedinf.2024.105352

•Real-time random safety audits are associated with a reduction in the risk of death.•Clinical information systems provide us with valuable real-world data.•Real-world data available is useful in assessing the impact of safety actions.•Real-time random safety audits improve care, especially in the most severe patients. Evidence-based care processes are not always applied at the bedside in critically ill patients. Numerous studies have assessed the impact of checklists and related strategies on the process of care and patient outcomes. We aimed to evaluate the effects of real-time random safety audits on process-of-care and outcome variables in critical care patients. This prospective study used data from the clinical information system to evaluate the impact of real-time random safety audits targeting 32 safety measures in two intensive care units during a 9-month period. We compared endpoints between patients attended with safety audits and those not attended with safety audits. The primary endpoint was mortality, measured by Cox hazard regression after full propensity-score matching. Secondary endpoints were the impact on adherence to process-of-care measures and on quality indicators. We included 871 patients; 228 of these were attended in ≥ 1 real-time random safety audits. Safety audits were carried out on 390 patient-days; most improvements in the process of care were observed in safety measures related to mechanical ventilation, renal function and therapies, nutrition, and clinical information system. Although the group of patients attended in safety audits had more severe disease at ICU admission [APACHE II score 21 (16−27) vs. 20 (15−25), p = 0.023]; included a higher proportion of surgical patients [37.3 % vs. 26.4 %, p = 0.003] and a higher proportion of mechanically ventilated patients [72.8 % vs. 40.3 %, p