“That is a new twist on evidence-based reports,” says James Battles, AHRQ's social science analyst for patient safety.
Of the 41 practices reviewed, 20 practices were deemed to have at least moderate evidence that they are effective, and 25 practices had at least moderate evidence that they could be successfully implemented in a typical hospital. The researchers combined that information to identify 10 practices that had sufficient evidence of both effectiveness and implementation to warrant being “strongly encouraged” for adoption, while another 12 practices were classified as those that should be “encouraged” (See chart).
In general, no one tracks hospital compliance with patient-safety measures. One exception is the CMS' core measures program, which has required hospitals since 2003 to report their compliance with certain practices for heart attack, pneumonia, heart failure and surgery patients.
Over time, however, the CMS has shifted its focus to outcomes measures such as readmission rates and hospital-acquired conditions. For example, the CMS tracks the number of catheter-associated urinary-tract infections in a hospital rather than the compliance with strategies to avoid them.
Private payers, meanwhile, are generally silent on patient-safety measures, says Dr. Sheldon Stadnyk, chief medical officer for Banner Health's Western Region. “My guess is that it may still be hard for them to measure,” he says.
That is because, except for core measures, U.S. hospitals are not working on a standard patient-safety agenda that requires them to track—or even to work on—the same patient-safety initiatives. Just because AHRQ's list shows the practices are proven to be effective, that does not automatically make them top priorities, Haraden says.
“You may think reducing mortality is the No. 1 priority, but some of those high-evidence practices really have very little effect on mortality,” Haraden says. “You can't do every single thing at once, so you have to look at your population and think about which practices are going to help your patients the most.”
Sarah Krein, a researcher at the VA Ann Arbor (Mich.) Healthcare System and the University of Michigan Health System, has studied the adoption of patient-safety practices for nearly a decade.
She says most hospitals are making a good-faith effort to improve patient safety, but as more is learned about how to improve safety, the number of safety initiatives keeps growing. “People are trying to respond,” she says. “But it becomes difficult when you're trying to use the limited resources that you have to address all of these different issues.”