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How effective are patient safety initiatives? A retrospective patient record review study of changes to patient safety over time.

Baines, R., Langelaan, M., Bruijne, M. de, Spreeuwenberg, P., Wagner, C. How effective are patient safety initiatives? A retrospective patient record review study of changes to patient safety over time. BMJ Quality & Safety: 2015, 24(9), 561-571
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Objectives
To assess whether, compared with previous years, hospital care became safer in 2011/2012, expressing itself in a fall in preventable adverse event (AE) rates alongside patient safety initiatives.

Design
Retrospective patient record review at three points in time.

Setting
In three national AE studies, patient records of 2004, 2008 and 2011/2012 were reviewed in, respectively, 21 hospitals in 2004, 20 hospitals in 2008 and 20 hospitals in 2011/2012. In each hospital, 400, 200 and 200 patient records were sampled, respectively.

Participants
In total, 15 997 patient admissions were included in the study, 7926 patient admissions from 2004, 4023 from 2008 and 4048 from 2011/2012.

Interventions
The main patient safety initiatives in hospital care at a national level between 2004 and 2012 have been small as well as large-scale multifaceted programmes.

Main outcome measures
Rates of both AEs and preventable AEs.

Results
Uncorrected crude overall AE rates showed no change in 2011/2012 in comparison with 2008, whereas preventable AE rates showed a reduction of 45%. After multilevel corrections, the decrease in preventable AE rate in 2011/2012 was still clearly visible with a decrease of 30% in comparison to 2008 (p=0.10). In 2011/2012, fewer preventable AEs were found in older age groups, or related to the surgical process, in comparison with 2008.

Conclusions
Our study shows some improvements in preventable AEs in the areas that were addressed during the comprehensive national safety programme. There are signs that such a programme has a positive impact on patient safety.