Findings from the SafeCare study underscore importance of patient safety, need for continued improvement
Study led by Boston area hospitals demonstrates a need for better tools, increased measurement of patient harm and improved implementation systems
Peer-Reviewed PublicationMore than 30 years ago, findings from the Harvard Medical Practice Study (HMPS) helped bring public awareness to the problem of patient safety. Since the publication of the HMPS results, new strategies for preventing specific types of adverse events have been put into place, but it has been challenging to measure the impact on patient care. To better understand what progress has been made in the last few decades, a team from Boston area hospitals conducted the SafeCare Study, which evaluated 11 hospitals in the region. Led by investigators from Mass General Brigham and sponsored by CRICO, the medical professional liability insurer for the Harvard medical community and its affiliated organizations, the study provides an estimate of adverse events in the inpatient environment, shedding light on the progress of two decades of work focused on improving patient safety and highlighting the need for continued improvement. Results are published in The New England Journal of Medicine.
“The study clearly demonstrates a need for better tools, increased measurement of patient harm, and better implementation systems,” said corresponding author David Westfall Bates, MD, medical director of Clinical and Quality Analysis for Mass General Brigham and chief of General Internal Medicine at Brigham and Women’s Hospital. “While we looked at hospitals in Massachusetts, improving the delivery of safe care is a national issue, not one that is specific to one hospital, system, state, or region. It’s valuable to know how much harm there is and for every institution to be aware of trends in adverse events so that they can take steps to mitigate and address issues within their walls.”
“Our work is a call to action for those from board to bedside to ensure reducing preventable patient harm is a top priority,” said Elizabeth Mort, MD, senior vice president of Quality and Safety at Massachusetts General Hospital and a co-author of the study. “Keep in mind that our study looked at patient safety before the COVID-19 pandemic. We know that our industry is now facing economic, workforce and wellness challenges nationally. Given these pressures, remaining focused and committed to patient safety is more important than ever.”
The SafeCare study followed a similar methodology to the HMPS, performed in 1984, although ways of capturing levels of harm have improved in the ensuing decades. Through review of 2,800 inpatient charts from patient visits in 2018 to hospitals ranging from large to small, the research team identified at least one adverse event in 23.6 percent of admissions. Overall, 23 percent of these adverse events were judged to be preventable given what is known today, and 32 percent had serious or higher clinical severity.
The leading causes of harm were medication related (39% of adverse events); surgery/procedural (30%); patient care, including falls and pressure ulcers (15%); and healthcare-associated infections (12%).
The rates of harm detected in the new study were higher than those from the HMPS, though different definitions were used. The authors note that the healthcare delivery system itself has changed dramatically since HMPS was conducted, with the advent of electronic health records and movement of complex care to ambulatory sites, leaving the most severely ill patients in our acute care hospitals. These changes present both challenges and opportunities.
“Because records are now computerized in nearly all hospitals, it should be possible to search them to make identification of these events much easier, which should in turn make it easier for hospitals to manage this area more effectively,” said Bates. “Based on our study, we are now taking steps to ensure that key findings do not get lost. We are also evaluating technological solutions that may help us better detect changes in respiratory rates, a patient’s pulse, and other early warning signs so that we can take steps to prevent or mitigate adverse events before they can cause harm.”
Bates and co-authors recommend that health care providers improve tracking of adverse drug effects, increase reliable and routine collection of data, deliver consistent and reliable care for healthcare-associated infections and work toward a culture that prioritizes safe, high-quality care.
“It’s important to do the work to identify adverse events if we’re going to work to improve them,” said Bates. “All organizations should have approaches for monitoring these things on a regular basis.”
Disclosures: Bates reports grants and personal fees from EarlySense; personal fees from CDI Negev; equity from ValeraHealth, Clew, and MDClone; personal fees and equity from AESOP and FeelBetter; and grants from IBM Watson Health, outside the submitted work. Co-author David Levine reports a grant and co-development with Biofourmis, grant from IBM, and fees from The MetroHealth System, all outside the submitted work. Co-authors Ania Syrowatka, Lynn Volk, Sevan Dulgarian, Mary Amato, and Heba Edrees received partial salary support from grants funded by IBM Watson Health, outside of the submitted work.
Funding: This study was supported by a grant from CRICO/Risk Management Foundation of the Harvard Medical Institutions.
Paper cited: Bates, DW et al. “The Safety of Inpatient Health Care” NEJM DOI: 10.1056/NEJMsa2206117
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About Mass General Brigham
Mass General Brigham is an integrated academic health care system, uniting great minds in medicine to make life-changing impact for patients in our communities and people around the world.
Mass General Brigham connects a full continuum of care across a system of academic medical centers, community and specialty hospitals, a health insurance plan, physician networks, community health centers, home care, and long-term care services.
Mass General Brigham is a non-profit organization that is committed to patient care, research, teaching, and service to the community. In addition, Mass General Brigham is one of the nation’s leading biomedical research organizations and a principal teaching affiliate of Harvard Medical School. For more information, please visit massgeneralbrigham.org.
Study led by Boston area hospitals demonstrates a need for better tools, increased measurement of patient harm and improved implementation systems
More than 30 years ago, findings from the Harvard Medical Practice Study (HMPS) helped bring public awareness to the problem of patient safety. Since the publication of the HMPS results, new strategies for preventing specific types of adverse events have been put into place, but it has been challenging to measure the impact on patient care. To better understand what progress has been made in the last few decades, a team from Boston area hospitals conducted the SafeCare Study, which evaluated 11 hospitals in the region. Led by investigators from Mass General Brigham and sponsored by CRICO, the medical professional liability insurer for the Harvard medical community and its affiliated organizations, the study provides an estimate of adverse events in the inpatient environment, shedding light on the progress of two decades of work focused on improving patient safety and highlighting the need for continued improvement. Results are published in The New England Journal of Medicine.
“The study clearly demonstrates a need for better tools, increased measurement of patient harm, and better implementation systems,” said corresponding author David Westfall Bates, MD, medical director of Clinical and Quality Analysis for Mass General Brigham and chief of General Internal Medicine at Brigham and Women’s Hospital. “While we looked at hospitals in Massachusetts, improving the delivery of safe care is a national issue, not one that is specific to one hospital, system, state, or region. It’s valuable to know how much harm there is and for every institution to be aware of trends in adverse events so that they can take steps to mitigate and address issues within their walls.”
“Our work is a call to action for those from board to bedside to ensure reducing preventable patient harm is a top priority,” said Elizabeth Mort, MD, senior vice president of Quality and Safety at Massachusetts General Hospital and a co-author of the study. “Keep in mind that our study looked at patient safety before the COVID-19 pandemic. We know that our industry is now facing economic, workforce and wellness challenges nationally. Given these pressures, remaining focused and committed to patient safety is more important than ever.”
The SafeCare study followed a similar methodology to the HMPS, performed in 1984, although ways of capturing levels of harm have improved in the ensuing decades. Through review of 2,800 inpatient charts from patient visits in 2018 to hospitals ranging from large to small, the research team identified at least one adverse event in 23.6 percent of admissions. Overall, 23 percent of these adverse events were judged to be preventable given what is known today, and 32 percent had serious or higher clinical severity.
The leading causes of harm were medication related (39% of adverse events); surgery/procedural (30%); patient care, including falls and pressure ulcers (15%); and healthcare-associated infections (12%).
The rates of harm detected in the new study were higher than those from the HMPS, though different definitions were used. The authors note that the healthcare delivery system itself has changed dramatically since HMPS was conducted, with the advent of electronic health records and movement of complex care to ambulatory sites, leaving the most severely ill patients in our acute care hospitals. These changes present both challenges and opportunities.
“Because records are now computerized in nearly all hospitals, it should be possible to search them to make identification of these events much easier, which should in turn make it easier for hospitals to manage this area more effectively,” said Bates. “Based on our study, we are now taking steps to ensure that key findings do not get lost. We are also evaluating technological solutions that may help us better detect changes in respiratory rates, a patient’s pulse, and other early warning signs so that we can take steps to prevent or mitigate adverse events before they can cause harm.”
Bates and co-authors recommend that health care providers improve tracking of adverse drug effects, increase reliable and routine collection of data, deliver consistent and reliable care for healthcare-associated infections and work toward a culture that prioritizes safe, high-quality care.
“It’s important to do the work to identify adverse events if we’re going to work to improve them,” said Bates. “All organizations should have approaches for monitoring these things on a regular basis.”
Disclosures: Bates reports grants and personal fees from EarlySense; personal fees from CDI Negev; equity from ValeraHealth, Clew, and MDClone; personal fees and equity from AESOP and FeelBetter; and grants from IBM Watson Health, outside the submitted work. Co-author David Levine reports a grant and co-development with Biofourmis, grant from IBM, and fees from The MetroHealth System, all outside the submitted work. Co-authors Ania Syrowatka, Lynn Volk, Sevan Dulgarian, Mary Amato, and Heba Edrees received partial salary support from grants funded by IBM Watson Health, outside of the submitted work.
Funding: This study was supported by a grant from CRICO/Risk Management Foundation of the Harvard Medical Institutions.
Paper cited: Bates, DW et al. “The Safety of Inpatient Health Care” NEJM DOI: 10.1056/NEJMsa2206117
###
About Mass General Brigham
Mass General Brigham is an integrated academic health care system, uniting great minds in medicine to make life-changing impact for patients in our communities and people around the world.
Mass General Brigham connects a full continuum of care across a system of academic medical centers, community and specialty hospitals, a health insurance plan, physician networks, community health centers, home care, and long-term care services.
Mass General Brigham is a non-profit organization that is committed to patient care, research, teaching, and service to the community. In addition, Mass General Brigham is one of the nation’s leading biomedical research organizations and a principal teaching affiliate of Harvard Medical School. For more information, please visit massgeneralbrigham.org.
JOURNAL
New England Journal of Medicine
New England Journal of Medicine
DOI
METHOD OF RESEARCH
Observational study
Observational study
SUBJECT OF RESEARCH
People
People
ARTICLE TITLE
The Safety of Inpatient Health Care
The Safety of Inpatient Health Care
ARTICLE PUBLICATION DATE
12-Jan-2023
12-Jan-2023
COI STATEMENT
Bates reports grants and personal fees from EarlySense; personal fees from CDI Negev; equity from ValeraHealth, Clew, and MDClone; personal fees and equity from AESOP and FeelBetter; and grants from IBM Watson Health, outside the submitted work. Co-author David Levine reports a grant and co-development with Biofourmis, grant from IBM, and fees from The MetroHealth System, all outside the submitted work. Co-authors Ania Syrowatka, Lynn Volk, Sevan Dulgarian, Mary Amato, and Heba Edrees received partial salary support from grants funded by IBM Watson Health, outside of the submitted work.
Bates reports grants and personal fees from EarlySense; personal fees from CDI Negev; equity from ValeraHealth, Clew, and MDClone; personal fees and equity from AESOP and FeelBetter; and grants from IBM Watson Health, outside the submitted work. Co-author David Levine reports a grant and co-development with Biofourmis, grant from IBM, and fees from The MetroHealth System, all outside the submitted work. Co-authors Ania Syrowatka, Lynn Volk, Sevan Dulgarian, Mary Amato, and Heba Edrees received partial salary support from grants funded by IBM Watson Health, outside of the submitted work.
Study reveals significant lack of infection-surveillance training in home infusion therapy setting
Results published in AJIC demonstrate need for HIT-specific training resources to improve infection prevention efforts in rapidly growing healthcare space
Arlington, Va., January 12, 2023 – A study published today in the American Journal of Infection Control (AJIC) reveals that many home infusion therapy (HIT) staff receive no formal training on how to perform central line-associated bloodstream infection (CLABSI) surveillance. The study, conducted by researchers from Johns Hopkins University, also identified specific training barriers that should be addressed to improve infection surveillance in this rapidly growing healthcare space.
“There was a 300% increase in patients receiving HIT in the United States between 2008 and 2019, and many of these individuals are at risk for CLABSI,” said Sara C. Keller MD, MSHP, MPH, Johns Hopkins University School of Medicine, and an author on the published study. “Appropriate, accurate CLABSI surveillance to understand rates in the HIT setting is necessary to drive prevention efforts.”
Infection prevention and surveillance training approaches have not been well defined in the HIT setting. Additionally, most HIT agencies do not employ dedicated, trained infection preventionists or devote sufficient resources to CLABSI surveillance activities, due in part to lack of funds and lack of mandated reporting of healthcare-associated infections (HAIs) in HIT.
HIT involves the administration of medicines through a catheter. CLABSIs are serious infections that can occur when bacteria enter the bloodstream through central line catheters. According to the CDC, of patients who get a bloodstream infection from having a central line, up to 1 in 4 may die.
Keller and colleagues conducted qualitative interviews with 21 home infusion staff from five large HIT agencies covering 13 states and Washington, DC. Questions posed to the staff – all of whom perform surveillance activities – focused on their surveillance training, barriers to and facilitators for CLABSI surveillance, and barriers to training in CLABSI surveillance.
Researchers found that many HIT staff who perform surveillance received no formal training on CLABSI surveillance. Study participants described instead a range of informal training experiences that included learning on the job (even from similarly untrained co-workers), relying on prior experience, and attending conferences. Participants also highlighted three primary barriers to HIT CLABSI surveillance training: Lack of learning resources such as user-friendly toolkits that accommodate high workload and time pressures; lack of awareness of professional development resources available to them; and lack of formal training provided by their respective organizations.
“These findings illustrate that there is a great need for infection prevention personnel and expertise in HIT,” said Patricia Jackson, RN, BSN, CIC, FAPIC, 2023 APIC president. “This information should prompt a concerted effort to implement formal infection prevention and surveillance training for HIT staff, including the development and deployment of training tools specific to the HIT setting.”
About APIC
Founded in 1972, the Association for Professionals in Infection Control and Epidemiology (APIC) is the leading association for infection preventionists and epidemiologists. With more than 15,000 members, APIC advances the science and practice of infection prevention and control. APIC carries out its mission through research, advocacy, and patient safety; education, credentialing, and certification; and fostering development of the infection prevention and control workforce of the future. Together with our members and partners, we are working toward a safer world through the prevention of infection. Join us and learn more at apic.org.
About AJIC
As the official peer-reviewed journal of APIC, The American Journal of Infection Control (AJIC) is the foremost resource on infection control, epidemiology, infectious diseases, quality management, occupational health, and disease prevention. Published by Elsevier, AJIC also publishes infection control guidelines from APIC and the CDC. AJIC is included in Index Medicus and CINAHL. Visit AJIC at ajicjournal.org.
NOTE FOR EDITORS
“The Need to Expand the Infection Prevention Workforce in Home Infusion Therapy,” by Sara Keller, MD, MSHP, MPH; Opeyemi Oladapo-Shittu, MD, MPH, CPH; Susan M. Hannum, PhD; Alejandra B. Salinas, BS; Kimberly Weems, MPH; Jill Marsteller, PhD; Ayse P Gurses, PhD, MPH, MS; Sara E. Cosgrove, MD, MS was published online in AJIC on January 12, 2023. The article may be found at: https://doi.org/10.1016/j.ajic.2022.11.008
AUTHORS
Sara C. Keller, MD, MSHP, MPH (corresponding author: skeller9@jhmi.edu)
Johns Hopkins University School of Medicine, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Opeyemi Oladapo-Shittu, MBBS, MPH, CPH
Johns Hopkins University School of Medicine, Baltimore, MD, USA
Susan M. Hannum, PhD
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Alejandra B. Salinas, BS
Johns Hopkins University School of Medicine, Baltimore, MD, USA
Kimberly Weems, MPH
Johns Hopkins Hospital, Baltimore, MD, USA
Jill Marsteller, PhD
Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Ayse P Gurses, PhD, MPH, MS
Johns Hopkins University School of Medicine, Baltimore, MD, USA
Sara E. Cosgrove, MD, MS
Johns Hopkins University School of Medicine, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Hospital, Baltimore, MD, USA
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JOURNAL
American Journal of Infection Control
METHOD OF RESEARCH
Survey
SUBJECT OF RESEARCH
People
ARTICLE TITLE
The Need to Expand the Infection Prevention Workforce in Home Infusion Therapy
