Making Health Care Safer II

An Updated Critical Analysis of the Evidence for Patient Safety Practices

Published In: Evidence Report/Technology Assessment, no. 211(Rockville, MD: Agency for Healthcare Research and Quality, Mar. 2013), p. 1-945

Posted on RAND.org on March 01, 2013

by Paul G. Shekelle, Robert M Wachter, Peter J. Pronovost, Scott Lucas, Meredith Noble, James T. Reston, Karen Schoelles, Nancy Sullivan, Fang Sun, Kelley Tipton, Jonathan R. Treadwell, Amy Tsou, Sallie J. Weaver, Bradford D. Winters, Elizabeth Pfoh, Renee Wilson, Kathryn Martinez, Sydney Dy, Zack Berger, Breanne Johnsen, Jody Larkin, Aneesa Motala, Roberta M. Shanman, Kathryn M McDonald, Sumant R. Ranji, Stephanie Rennke, Eric Schmidt, Kaveh G Shojania, Sydne Newberry, Mary E. Vaiana

Read More

Access further information on this document at www.ahrq.gov

This article was published outside of RAND. The full text of the article can be found at the link above.

OBJECTIVES: To review important patient safety practices for evidence of effectiveness, implementation, and adoption. DATA SOURCES: Searches of multiple computerized databases, gray literature, and the judgments of a 20-member panel of patient safety stakeholders. REVIEW METHODS: The judgments of the stakeholders were used to prioritize patient safety practices for review, and to select which practices received in-depth reviews and which received brief reviews. In-depth reviews consisted of a formal literature search, usually of multiple databases, and included gray literature, where applicable. In-depth reviews assessed practices on the following domains: --How important is the problem? --What is the patient safety practice? --Why should this practice work? --What are the beneficial effects of the practice? --What are the harms of the practice? --How has the practice been implemented, and in what contexts? --Are there any data about costs? --Are there data about the effect of context on effectiveness? We assessed individual studies for risk of bias using tools appropriate to specific study designs. We assessed the strength of evidence of effectiveness using a system developed for this project. Brief reviews had focused literature searches for focused questions. All practices were then summarized on the following domains: scope of the problem, strength of evidence for effectiveness, evidence on potential for harmful unintended consequences, estimate of costs, how much is known about implementation and how difficult the practice is to implement. Stakeholder judgment was then used to identify practices that were "strongly encouraged" for adoption, and those practices that were "encouraged" for adoption. RESULTS: From an initial list of over 100 patient safety practices, the stakeholders identified 41 practices as a priority for this review: 18 in-depth reviews and 23 brief reviews. Of these, 20 practices had their strength of evidence of effectiveness rated as at least "moderate," and 25 practices had at least "moderate" evidence of how to implement them. Ten practices were classified by the stakeholders as having sufficient evidence of effectiveness and implementation and should be "strongly encouraged" for adoption, and an additional 12 practices were classified as those that should be "encouraged" for adoption. CONCLUSIONS: The evidence supporting the effectiveness of many patient safety practices has improved substantially over the past decade. Evidence about implementation and context has also improved, but continues to lag behind evidence of effectiveness. Twenty-two patient safety practices are sufficiently well understood, and health care providers can consider adopting them now.

Research conducted by

This report is part of the RAND Corporation external publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.