Safer Patients Initiative

Staff are looking at ways to improve infection control

Around 16 million people are admitted to hospital each year in the UK¹. The majority are treated safely and successfully. However, a disturbingly high number will find that something goes wrong with their treatment or care, resulting in unnecessary harm, pain and suffering, sometimes leading to death. Estimates suggest that one in ten patients in hospital experiences an incident which puts their safety at risk, and that about half of these could have been prevented².

The Health Foundation’s Safer Patients Initiative was set up to address this problem and find ways of making hospitals safer for patients.

What are we doing?

The Safer Patients Initiative has been run in two phases – the first starting in 2004 and including four hospitals, the second starting in 2006 and including 20 hospitals.

Phase one – 2004 to present

Since 2004, The Health Foundation has been supporting four hospitals in a £4.3 million four-year initiative to test ways of improving safety on an organisation-wide basis. The hospitals, Luton and Dunstable Hospital NHS Trust; Conwy and Denbighshire NHS Trust; Down Lisburn Health and Social Services Trust (now South Eastern Health and Social Care Trust); and NHS Tayside, are working with international experts from the Institute for Healthcare Improvement (IHI), to develop their expertise in patient safety.

All four sites are following a programme designed by IHI for the Safer Patients Initiative, which works on three levels:

• addressing five clinical areas, each containing multiple interventions that have an established and accepted evidence base in the UK (such as better management of patients in intensive care, infection control, preventative antibiotics for surgery and medicines safety)
• teaching methods for quality and safety improvement
• establishing a specific role for the chief executives and senior executive team.
  

Phase two – 2006 to present

To meet our vision of transforming patient safety in UK, in 2006, the Safer Patients Initiative was expanded from the initial four hospitals to another twenty, spread across the UK. Each of the additional twenty hospitals will receive £165,000 plus a tailored support package of similar value. The hospitals will work in pairs on the safety improvement work and will work with international patient safety experts from the US-based Institute for Healthcare Improvement.

The 20 hospitals involved in the second phase are aiming to reduce their mortality rate by at least 15 percent and to reduce adverse events by at least 30 percent over the two year period (2006 to 2008).

Over the next two years, the hospitals will develop their expertise to drive forward system-wide improvements so that unintended harm, errors or mistakes are less likely to happen. The initiative will test out ways of making care safer in three areas of the hospital – on the wards, before, during and after operations and in critical care. In each of these settings staff will look at ways to improve infection control, the management of drugs and communication between staff teams and patients.

The 20 hospitals that joined the scheme in 2006 are:

For more information, contact saferpatients@health.org.uk

What are the results?

Results released in November 2006 showed impressive safety improvements at the four hospitals. After just two years, they had on average halved their number of medical mistakes. NHS Tayside has seen its adverse event (unintended harm to patients) rate fall by almost three quarters. In addition, the hospitals are seeing some knock-on improvements in their mortality rates. For example, Luton and Dunstable Hospital NHS Foundation Trust’s standardised mortality rate has improved from being 11 per cent worse than average (in 2005) to being 11 per cent better than average (last quarter 2006).

At Conwy and Denbighshire NHS Trust, pneumonia on the intensive care unit associated with assisted ventilation had been virtually eliminated by November 2006, from a previous level of 30 per cent. Patients were spending less time in the unit and needed fewer medications. This resulted in a saving of £78,000 in the medicines budget and allowed 350 more patients to be treated over the last two years.

Also by November 2006, NHS Tayside increased its hand hygiene compliance to 96 per cent on the general wards, which in turn helped to reduce hospital-acquired infections. Down Lisburn Health and Social Services Trust reduced the number of medication errors to below 10 per cent, following the development of a system for tracking and managing the drugs their patients take. The system is also linked to GP patient records and is helping to reduce mistakes in the primary care setting.

Luton and Dunstable Hospital NHS Foundation Trust estimates that there are between one and two fewer cardiac arrests per week since the introduction of an early warning score system on the wards. The system allows staff to monitor patients’ conditions and to take rapid action if they go into decline. It has led to a fall in the crash call rate as the rapid response team can now take action sooner to avoid patients developing serious life threatening conditions.

References

1. Yuen P. Office of Health Economics Compendium 17th Edition, 2005–06 London: Office of Health Economics, 2005
2. Sources: Vincent, Neale and Woloshynowych “Adverse events in British hospitals: preliminary retrospective record review” in British Medical Journal Vol 322 3 March 2001 and Emslie, Knox and Pickstone (eds), Improving Patient Safety: Insights from American, Australian and British Healthcare ECRI Europe, 2002