CLINICAL ISSUES
Measuring Perinatal Patient Safety: Review of Current Methods

https://doi.org/10.1111/j.1552-6909.2006.00060.xGet rights and content

Methods to measure patient safety include structure, process and outcome measures, safety attitude and climate surveys, focus groups, storytelling, executive walk rounds, and external review. Ideally, measures of patient safety should be meaningful, science based, psychometrically sound, feasible, and actionable. Accurate and timely data feedback to caregivers is critical to effect required changes. A balanced set of patient safety measures provides valuable data to guide efforts to improve perinatal patient safety. JOGNN, 35, 432‐442;2006. DOI: 10.1111/J.1552‐6909.2006.00060.x

Section snippets

What is Patient Safety?

The Institute of Medicine (IOM) (Kohn, Corrigan, & Donaldson, 1999) defined patient safety as freedom from injuries or harm to patients from care that is intended to help them. The Agency for Healthcare Research and Quality (AHRQ, 2003) definition is similar: freedom from potentially preventable complications, iatrogenic events, accidental injury, or illness resulting from the processes of care. In other words, patients should not be harmed as a result of their encounters with the health care

Current Methods of Measuring Patient Safety

Safety is the absence of patient harm due to the process of care. Measuring things that do not occur is a challenge. Nonetheless, various methods have been proposed as measures of patient safety, each with advantages and limitations. These include structure, process, and outcomes measures. Structure measures cover the organizational context of care, such as the existence of an interdisciplinary practice committee and key clinical protocols for areas of care known to be associated with patient

External Review and Risk Assessment

The leadership team in a hospital or health care system often desires external review to determine the state of perinatal patient safety. Generally, this process includes a review of current clinical practices, policies and protocols, selected medical records, recent sentinel events, and open and closed obstetric professional liability claims. Interviews with key members of the leadership team and individual care providers add qualitative data and confirmation of clinical practices identified

Summary

There is widespread consensus that health care organizations can reduce patient harm and injuries by improving the environment for safety, with actions ranging from implementing technical and clinical changes to heightening staff member awareness of patient safety risks (AHRQ, 2003). In order to begin plans for improvement, methods of measuring patient safety must be in place to provide the leadership team and direct caregivers with accurate data concerning gaps in the safety net.

An ongoing

References (28)

  • S.C. Beyea et al.

    Learning from stories: A pathway to patient safety

    AORN Journal

    (2004)
  • P.J. Pronovost et al.

    How can clinicians measure safety and quality in acute care?

    Lancet

    (2004)
  • Agency for Healthcare Research and Quality (AHRQ)

    Quality indicators: Guide to patient safety indicators

    (2003)
  • Agency for Healthcare Research and Quality (AHRQ)

    Hospital Survey on Patient Safety Culture

    (2004)
  • Agency for Healthcare Research and Quality (AHRQ)

    Quality indicators software and user guide

    (2005)
  • L.H. Aiken et al.

    Measuring organizational traits of hospitals: The revised nursing work index

    Nursing Research

    (2000)
  • American Academy of Pediatrics

    Circumcision policy statement

    (1999)
  • American Academy of Pediatrics & Canadian Paediatric Society

    Prevention and management of pain and stress in the neonate

    (2000)
  • American College of Obstetricians and Gynecologists

    Induction of labor

    (1999)
  • American College of Obstetricians and Gynecologists

    Prevention of early‐onset group B streptococcal disease in newborns

    (2002)
  • American College of Obstetricians and Gynecologists

    Prenatal and perinatal human immunodeficiency virus testing: Expanded recommendations

    (2004)
  • E.H. Bradley et al.

    Data feedback efforts in quality improvement: Lessons learned from US hospitals

    Quality and Safety in Healthcare

    (2004)
  • J.B. Colla et al.

    Measuring patient safety climate: A review of surveys

    Quality and Safety in Healthcare

    (2005)
  • S.N. Hesse-Biber et al.

    The practice of qualitative research

    (2006)
  • Cited by (23)

    • Failure to rescue as a center-level metric in pediatric trauma

      2019, Surgery (United States)
      Citation Excerpt :

      In line with this, FTR rates have been shown to follow a stepwise increase from low-mortality to high-mortality centers, whereas complication rates do not vary significantly between high-volume and low-volume centers.5–7,10 FTR has been useful in evaluating pediatric quality of care in pediatric liver transplantation,11 cardiac surgery,12 obstetrics,13–15 for children’s hospitals,16,17 and as a measure of racial or ethnic disparities among congenital heart surgery pediatric patients.18 However, this metric is poorly described for pediatric trauma.

    • On the relationship between safety climate and occupational burnout in healthcare organizations

      2016, Safety Science
      Citation Excerpt :

      Therefore, in order to reduce occupational burnout among nurses, personnel planning should be in such a way to improve the gap between nurses and supervisors, with an emphasis on travel tours, team camps, etc. Leadership Walk Rounds (WRs) have been widely used as an effective tool to improve safety culture in healthcare organizations as well as many different aspects of the work environment (Simpson, 2006). WR is a structured process to bring senior supervisors and front line staff together to have quality and safety conversations with to the aim of preventing, detecting and mitigating patient/staff harms.

    • Patient outcomes in the field of nursing: A concept analysis

      2014, International Journal of Nursing Sciences
    • Standardizing the Words Nurses Use to Document Elements of Perinatal Failure to Rescue

      2014, JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing
    • Michigan Health & Hospital Association Keystone Obstetrics: A statewide collaborative for perinatal patient safety in Michigan

      2011, Joint Commission Journal on Quality and Patient Safety
      Citation Excerpt :

      Each of the four components of the tool has a possible score ranging from 0 to 2 (0 = meets < 50% of applicable criteria; 1 = meets 50% or more but less than 100% of applicable criteria; 2 = meets all applicable criteria), with a total possible score of 8. Content validity and interrater reliability of this tool has been established in previous studies; interrater reliability has ranged from 90% to 92%.34–36 All eligible cases (N = 25,705 term births [≥ 37 weeks gestation]) of women with a singleton pregnancy who potentially could have had an elective labor induction or elective cesarean birth were included.

    View all citing articles on Scopus
    View full text