What Challenges Do Hospitals Face Using Evidence-Based Safety Practices?

GAO found that the first challenge to improving hospital safety can be getting good data about one's own institution.

Patient safety is a priority for payers, including CMS—and ultimately Congress. It recently asked the Government Accountability Office (GAO) to look into why there can be disconnects between known evidence-based patient safety standards and getting hospitals to act on them.

For help, GAO turned to patient safety experts from 6 hospitals that had performed well on certain safety measures, as well as 6 insurers, officials from CMS, and the Agency for Healthcare Research and Quality.

What the GAO found were a variety of ideas and incentives to promote safety, both financial and non-financial. Items such as peer-led training, technical assistance and support, and giving staff access to data on best practices helped contribute to a 17% reduction in certain adverse events from 2010 to 2014, according to AHRQ.

However, the GAO found there are 3 common barriers to implementing evidence-based patient safety practices:

· Getting good data about one’s own hospital. It takes time and resources to gather data about adverse events, and it also takes time to disseminate it.

· Deciding what to do first. Hospital officials said sometimes there are questions whether evidence about a patient safety practice is solid or limited. One hospital told GAO that it tried more than one strategy to reduce patient falls without knowing which one would be effective.

· Making sure staff are consistent with practices. Hospitals can’t just send a memo and hope a change sticks. They have to constantly monitor results to make sure that a change lasts over time, and they have to anticipate and correct any implementation problems.

The good news, according to GAO, is that taking action can yield dramatic results. One hospital reported a 40% reduction in certain infections in a 1-year period after hiring a special infection control nurse.

CMS and private payers have start tying financial rewards to patient safety, including reductions in adverse events. Payers may also offer other support that can feed into the safety scores published by entities such as the Leapfrog Group, which are becoming more and more part of hospital marketing efforts, as patients become savvy consumers.

Last fall, at the ACO and Emerging Health Delivery Coalition fall meeting, convened by The American Journal of Managed Care, Leapfrog CEO Leah Binder, MA, MHA, said patient safety is very important to consumers and something they value when selecting a hospital.