In a bid to clean up misleading institutional safety comparisons and go further to fix safety problems, Johns Hopkins experts are proposing standard guidelines to be used as hospital safety rating tools.
“Hospitals are increasingly reporting patient safety data on their Web sites,” says Peter Pronovost, M.D., Ph.D., medical director of the Johns Hopkins Center for Innovation in Quality Patient Care. “While this is long overdue, the data is only helpful if it's accurate. The absence of proper oversight in measuring and reporting patient safety not only could mean some problems aren't being fixed but also that the public is potentially being misled.”
In an article published in the Nov. 7 issue of the Journal of the American Medical Association (JAMA), Pronovost, an anesthesiologist and critical care specialist, and a team of Johns Hopkins researchers adapted elements of the well-known Users' Guide to the Medical Literature: A Manual for Evidence-Based Clinical Practice, to construct what they say are guidelines that hospitals can use to ensure validity and accuracy in patient safety reporting.
“The guide has been used successfully for years to help clinicians evaluate the validity and accuracy of research data they might want to use in their own practice,” says Pronovost. “We propose using the same principles to evaluate the validity and accuracy of the methods used by an institution to gauge patient safety.”
Like the clinical practice assessments, the new guidelines, Pronovost says, address three key questions: Are the measures important, are they valid and are they useful for the goal intended, in this case to improve safety in health care organizations"
These larger concepts are addressed in an assessment tool that comprises some 30 questions, such as: Is the measure required by an external group or agency" Is the measure supported by empiric evidence or a consensus of experts" Does the measure have face validity - do clinicians believe that improvement in performance on the measure will be associated with improved patient outcomes" Is the risk for selection bias minimized"
Patient safety reporting came to the forefront in 1999 after the Institute of Medicine issued its report “To Err is Human,” which documented widespread risk to patients. In response, the Centers for Medicare and Medicaid Service (CMS) and the Joint Commission began requiring all hospitals to submit annual patient safety reports.