Multiple component patient safety intervention in English hospitals: controlled evaluation of second phase

• Published in: BMJ 2011-02, Vol.342 (7793), p.370-370
• Main Authors: Benning, Amirta, Dixon-Woods, Mary, Nwulu, Ugochi, Ghaleb, Maisoon, Dawson, Jeremy, Barber, Nick, Franklin, Bryony Dean, Girling, Alan, Hemming, Karla, Carmalt, Martin, Rudge, Gavin, Naicker, Thirumalai, Kotecha, Amit, Derrington, M Clare, Lilford, Richard
• Format: Article
• Language: English
• Subjects: Acute Disease - therapy; Adult Intensive Care; Attitude surveys; Case-Control Studies; Clinical trials; Critical Care - standards; England; Epidemiologic Studies; General Surgery; Hand Disinfection - standards; Health care; Health surveys; Hospital Mortality; Hospital units; Hospitalization; Hospitals; Hospitals, Public - standards; Humans; Infection Control - standards; Infections; Infectious Diseases; Intensive care; Intervention; Intraoperative Care - standards; Medical Error/ Patient Safety; Medical Errors; Medical History Taking; Medical screening; Medicines Regulation; Methicillin; Methicillin-Resistant Staphylococcus aureus; Mortality; Overtime; Patient safety; Patient Satisfaction; Patients; Pneumonia (Respiratory Medicine); Professional Practice - standards; Prophylaxis; Psychoeducational intervention; Quality of Health Care; Respiration; Respiratory diseases; Safety Management; Staphylococcal Infections - prevention & control; Temperature effects; Thrombosis
• ISSN: 0959-8138; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.d199

Objective To independently evaluate the impact of the second phase of the Health Foundation’s Safer Patients Initiative (SPI2) on a range of patient safety measures.Design A controlled before and after design. Five substudies: survey of staff attitudes; review of case notes from high risk (respiratory) patients in medical wards; review of case notes from surgical patients; indirect evaluation of hand hygiene by measuring hospital use of handwashing materials; measurement of outcomes (adverse events, mortality among high risk patients admitted to medical wards, patients’ satisfaction, mortality in intensive care, rates of hospital acquired infection).Setting NHS hospitals in England.Participants Nine hospitals participating in SPI2 and nine matched control hospitals.Intervention The SPI2 intervention was similar to the SPI1, with somewhat modified goals, a slightly longer intervention period, and a smaller budget per hospital.Results One of the scores (organisational climate) showed a significant (P=0.009) difference in rate of change over time, which favoured the control hospitals, though the difference was only 0.07 points on a five point scale. Results of the explicit case note reviews of high risk medical patients showed that certain practices improved over time in both control and SPI2 hospitals (and none deteriorated), but there were no significant differences between control and SPI2 hospitals. Monitoring of vital signs improved across control and SPI2 sites. This temporal effect was significant for monitoring the respiratory rate at both the six hour (adjusted odds ratio 2.1, 99% confidence interval 1.0 to 4.3; P=0.010) and 12 hour (2.4, 1.1 to 5.0; P=0.002) periods after admission. There was no significant effect of SPI for any of the measures of vital signs. Use of a recommended system for scoring the severity of pneumonia improved from 1.9% (1/52) to 21.4% (12/56) of control and from 2.0% (1/50) to 41.7% (25/60) of SPI2 patients. This temporal change was significant (7.3, 1.4 to 37.7; P=0.002), but the difference in difference was not significant (2.1, 0.4 to 11.1; P=0.236). There were no notable or significant changes in the pattern of prescribing errors, either over time or between control and SPI2 hospitals. Two items of medical history taking (exercise tolerance and occupation) showed significant improvement over time, across both control and SPI2 hospitals, but no additional SPI2 effect. The holistic review showed no significant changes in e