PMID- 28661998
OWN - NLM
STAT- MEDLINE
DCOM- 20210222
LR  - 20210222
IS  - 1549-8425 (Electronic)
IS  - 1549-8417 (Linking)
VI  - 16
IP  - 4
DP  - 2020 Dec
TI  - Description and Yield of Current Quality and Safety Review in Selected US 
      Academic Emergency Departments.
PG  - e245-e249
LID - 10.1097/PTS.0000000000000379 [doi]
AB  - OBJECTIVES: Quality and safety review for performance improvement is important 
      for systems of care and is required for US academic emergency departments (EDs). 
      Assessment of the impact of patient safety initiatives in the context of 
      increasing burdens of quality measurement compels standardized, meaningful, 
      high-yield approaches for performance review. Limited data describe how quality 
      and safety reviews are currently conducted and how well they perform in detecting 
      patient harm and areas for improvement. We hypothesized that decades-old 
      approaches used in many academic EDs are inefficient and low yield for 
      identifying patient harm. METHODS: We conducted a prospective observational study 
      to evaluate the efficiency and yield of current quality review processes at five 
      academic EDs for a 12-month period. Sites provided descriptions of their current 
      practice and collected summary data on the number and severity of events 
      identified in their reviews and the referral sources that led to their capture. 
      Categories of common referral sources were established at the beginning of the 
      study. Sites used the Institute for Healthcare Improvement's definition in 
      defining an adverse event and a modified National Coordinating Council for 
      Medication Error Reporting and Prevention (MERP) Index for grading severity of 
      events. RESULTS: Participating sites had similar processes for quality review, 
      including a two-level review process, monthly reviews and conferences, similar 
      screening criteria, and a grading system for evaluating cases. In 60 months of 
      data collection, we reviewed a total of 4735 cases and identified 381 events. 
      This included 287 near-misses, errors/events (MERP A-I) and 94 adverse events 
      (AEs) (MERP E-I). The overall AE rate (event rate with harm) was 1.99 (95% 
      confidence interval = 1.62%-2.43%), ranging from 1.24% to 3.47% across sites. The 
      overall rate of quality concerns (events without harm) was 6.06% (5.42%-6.78%), 
      ranging from 2.96% to 10.95% across sites. Seventy-two-hour returns were the most 
      frequent referral source used, accounting for 47% of the cases reviewed but with 
      a yield of only 0.81% in identifying harm. Other referral sources similarly had 
      very low yields. External referrals were the highest yield referral source, with 
      14.34% (10.64%-19.03%) identifying AEs. As a percentage of the 94 AEs identified, 
      external referrals also accounted for 41.49% of cases. CONCLUSIONS: With an 
      overall adverse event rate of 1.99%, commonly used referral sources seem to be 
      low yield and inefficient for detecting patient harm. Approximately 6% of the 
      cases identified by these criteria yielded a near miss or quality concern. New 
      approaches to quality and safety review in the ED are needed to optimize their 
      yield and efficiency for identifying harm and areas for improvement.
FAU - Griffey, Richard Thomas
AU  - Griffey RT
AD  - From the Division of Emergency Medicine, Washington University in St. Louis, St. 
      Louis, Missouri.
FAU - Schneider, Ryan M
AU  - Schneider RM
AD  - From the Division of Emergency Medicine, Washington University in St. Louis, St. 
      Louis, Missouri.
FAU - Sharp, Brian R
AU  - Sharp BR
AD  - Department of Emergency Medicine, University of Wisconsin School of Medicine and 
      Public Health, Madison, Wisconsin.
FAU - Pothof, Jeffrey J
AU  - Pothof JJ
AD  - Department of Emergency Medicine, University of Wisconsin School of Medicine and 
      Public Health, Madison, Wisconsin.
FAU - Hodkins, Sheridan
AU  - Hodkins S
AD  - Department of Emergency Medicine, University of Colorado School of Medicine, 
      Denver, Colorado.
FAU - Capp, Roberta
AU  - Capp R
AD  - Department of Emergency Medicine, University of Colorado School of Medicine, 
      Denver, Colorado.
FAU - Wiler, Jennifer L
AU  - Wiler JL
AD  - Department of Emergency Medicine, University of Colorado School of Medicine, 
      Denver, Colorado.
FAU - Sreshta, Neil
AU  - Sreshta N
AD  - Department of Emergency Medicine, Yale University School of Medicine, New Haven, 
      Connecticut.
FAU - Sather, John E
AU  - Sather JE
AD  - Department of Emergency Medicine, Yale University School of Medicine, New Haven, 
      Connecticut.
FAU - Sampson, Christopher S
AU  - Sampson CS
AD  - Department of Emergency Medicine, University of Missouri-Columbia School of 
      Medicine, Columbia, Missouri.
FAU - Powell, Jonathan T
AU  - Powell JT
AD  - Department of Emergency Medicine, Christiana Care, Wilmington, Delaware.
FAU - Groner, Kathryn Y
AU  - Groner KY
AD  - Department of Emergency Medicine, Christiana Care, Wilmington, Delaware.
FAU - Adler, Lee M
AU  - Adler LM
LA  - eng
GR  - R18 HS025052/HS/AHRQ HHS/United States
PT  - Journal Article
PL  - United States
TA  - J Patient Saf
JT  - Journal of patient safety
JID - 101233393
SB  - IM
MH  - Emergency Service, Hospital/*standards
MH  - Humans
MH  - Patient Safety/*standards
MH  - Prospective Studies
MH  - Quality of Health Care/*standards
MH  - United States
EDAT- 2017/07/01 06:00
MHDA- 2021/02/23 06:00
CRDT- 2017/06/30 06:00
PHST- 2017/07/01 06:00 [pubmed]
PHST- 2021/02/23 06:00 [medline]
PHST- 2017/06/30 06:00 [entrez]
AID - 01209203-202012000-00024 [pii]
AID - 10.1097/PTS.0000000000000379 [doi]
PST - ppublish
SO  - J Patient Saf. 2020 Dec;16(4):e245-e249. doi: 10.1097/PTS.0000000000000379.