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Value and Patient Safety

Last Updated: March 19, 2024
Created By: Lorri Zipperer, Cybrarian, AHRQ PSNet Team

Value as an element of patient safety is emerging as an approach to prioritize and evaluate improvement actions. This library highlights resources that explore the business case for cost effective, efficient and impactful efforts to reduce medical errors.
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Foundations (8)
Weeks WB, Bagian JP. Jt Comm J Qual Saf. 2003;29:51-4, 1.

While the costs of medical error to patients are well appreciated, the direct costs to institutions, especially if error does not result in litigation, are less so. Even when errors increase length of stay... Read More

Ken Lee KH, Matthew Austin J, Pronovost PJ. Value Health. 2015;19:323-325.

Value-based healthcare is emerging as a safety construct. This article discusses the primary definition of value in health care and how established quality measures can be used to demonstrate its... Read More

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Danello SH, Maddox RR, Schaack GJ. Hosp Pharm. 2010;44:680-688.

Implementation of smart infusion pumps resulted in both improved patient safety and cost savings, making a strong business case for investing in this patient safety intervention.

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All Library Content (24)
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Halligan D, Janes G, Conner M, et al. J Patient Saf. 2023;19:143-150.
Reducing low-value tests and treatments has been a focus of patient safety efforts, but less attention has been focused on low-value patient safety practices (PSP). This study describes the concept of “safety clutter” and understanding which PSP are of low-value, ineffective, and could be discontinued. Frequently cited PSP included paperwork, duplication, and intentional rounding.
Leendertse AJ, van den Bemt PMLA, Poolman JB, et al. Value Health. 2011;14:34-40.
Adverse drug events (ADE) in the outpatient setting can result in hospital admission and are largely preventable. This study used data from the earlier Hospital Admissions Related to Medication (HARM) study to estimate the cost (medical cost to the health system and loss of patient productivity) of each ADE-related hospital admission. The expense of each ADE can be significant, suggesting programs to reduce ADE may be cost-neutral or cost-saving.
Ken Lee KH, Matthew Austin J, Pronovost PJ. Value Health. 2015;19:323-325.
Value-based healthcare is emerging as a safety construct. This article discusses the primary definition of value in health care and how established quality measures can be used to demonstrate its effectiveness in system improvement.

Washington, DC: Veterans Affairs Office of Inspector General; 2022. Report No. 22-00818-03.

Organizational evaluations often reveal opportunities to address persistent quality and safety issues. This extensive inspection report shares findings from examinations at 45 Veterans Health Administration care facilities that focused on assessing oversight, system redesign and surgical programs. Recommendations drawn from the analysis call for improvements in protected peer review, surgical work structure and surgical adverse incident examination.

Nudges are a change in the way choices are presented or information is framed that can have a large, but predictable, impact on medical decision-making, for both patients and providers without actually restricting individual choice. The Nudge Unit at Penn Medicine focuses on a range of different care improvement projects, including safety initiatives, with this framework in mind that are designed to improve workflow, support evidence-based decision-making, and create sustained changes in patient engagement and daily behaviors.1

Jochen Profit, MD, MPH; Annette Scheid, MD; and Erick Ridout, MD |
This piece describes a collaborative, interdisciplinary team approach with a flat hierarchy used at Intermountain Healthcare's Dixie Regional Medical Center that led to substantial reduction of key neonatal morbidities and costs of care.
Dr. Shah is an Assistant Professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School and Director of the Delivery Decisions Initiative at Harvard's Ariadne Labs. He is also the founder of the organization Costs of Care. We spoke with him about patient safety in obstetrics, maternal mortality, the importance of dignity, and the overuse of cesarean deliveries.
Judson TJ, Press MJ, Detsky AS. Healthc (Amst). 2019;7:4-6.
Health care is working to provide high-value care and prevent overuse while ensuring patient safety. This commentary highlights the importance of educational initiatives, mentors, and use of clinical decision support to help clinicians determine what amount of care is appropriate for a given clinical situation.
Arefian H, Vogel M, Kwetkat A, et al. PLoS One. 2016;11:e0146381.
Health care–associated infections are a longstanding patient safety priority, and intensive multifaceted interventions have been shown to prevent them. This systematic review examined economic analyses of interventions to prevent hospital-acquired infections and found highly positive cost–benefit ratios. Although the authors raised concerns that quality of reporting in the identified studies was low, they concluded that preventing hospital-acquired infections is a cost-effective patient safety strategy. A PSNet perspective on the business case for patient safety discussed health care–associated infections.
Institute for Healthcare Improvement, National Patient Safety Foundation. Cambridge, MA: Institute for Healthcare Improvement; 2017.
Although patient safety is considered a noble goal in health care, garnering the resources for improvement efforts can be hindered by other demands. This toolkit provides strategies for health care leaders to develop a business case for patient safety efforts to generate support for organizational investments. Materials include assessments and templates for financial documents and presentation materials.
Slawomirski L, Auraaen A, Klazinga N. Organisation for Economic Co-operation and Development: Paris, France; 2017.
Failures in patient care are a global concern. Examining the literature on costs of unsafe care delivery, this report describes the financial impacts of medical error and reviews methods of addressing these issues in resource-limited environments to improve care value and efficiency while enhancing patient safety.
Austin M, Demski R, Callender T, et al. Jt Comm J Qual Patient Saf. 2017;43:166-175.
Improving safety in health care organizations requires commitment from senior leadership and governance. It also requires an organizational structure that facilitates identifying and addressing safety issues. This study describes the organizational structure used at Johns Hopkins Medicine to prioritize improving quality, safety, and value. The organization developed a reporting and oversight framework using four key principles: governance from the hospital board's dedicated patient safety and quality committee, shared accountability between the board and clinical leadership, a consolidated quality performance statement to ensure transparency around goals and priorities, and internal audits to ensure reliability and accuracy of safety and quality data. The authors provide examples of how this framework was used to address safety issues such as health care–associated infections. An earlier article described Johns Hopkins' success at achieving consistently high performance on accountability measures.
Weeks WB, Bagian JP. Jt Comm J Qual Saf. 2003;29:51-4, 1.
While the costs of medical error to patients are well appreciated, the direct costs to institutions, especially if error does not result in litigation, are less so. Even when errors increase length of stay or require additional interventions, these events usually represent billable charges and are not, from a purely economic standpoint, injurious to the institution. The authors, while acknowledging the ethical and societal imperatives to improve safety, outline the “business case” for patient safety investment, arguing that the long-term benefits to an organization’s reputation, efficiency, and medico-legal defensibility compensate for the sometimes high up-front costs of implementation.
Stinnett-Donnelly JM, Stevens PG, Hood VL. BMJ Qual Saf. 2016;25:901-908.
This quality improvement project sought to prevent harmful or unnecessary care through a combination of electronic health record alerts and provider education. Three of five completed projects undertaken demonstrated success in reducing the unneeded intervention: fewer serum creatinine tests ordered in those with end stage renal disease, fewer portable chest radiographs ordered in the intensive care unit, and fewer bone-density scans ordered in average-risk women under age 65. The authors cite leadership support, frontline clinician engagement, and inclusion of trainees as factors that contributed to success of their interventions.
Roundtable on Value and Science Driven Healthcare; Institute of Medicine. Washington, DC: National Academies Press; 2013. ISBN: 9780309288965.
This publication reports on a workshop that explored methods to engage patients and families in safety improvement efforts, including shared decision making and providing information to consumers about costs.
Forrester SH, Hepp Z, Roth JA, et al. Value Health. 2014;17:340-349.
Most research on computerized provider order entry (CPOE) has focused on its role in preventing medication errors. This modeling study sought to determine the cost-effectiveness of CPOE in the ambulatory setting. The authors used prior data on changes in adverse drug event rates both before and after implementation of electronic prescribing to estimate the benefit of CPOE for outpatient medication safety. Exploring four simulations varying in practice sizes and characteristics, they found that CPOE was cost-effective and associated with fewer medication errors. These data support further implementation of electronic prescribing, despite concerns about introducing new errors with health information technology. A previous AHRQ WebM&M perspective discusses how to design safer CPOE systems.
Zimlichman E, Keohane C, Franz C, et al. Jt Comm J Qual Patient Saf. 2013;39:312-318.
The uptake of computerized provider order entry (CPOE) in community hospitals has been slow due to difficulties associated with implementation and uncertainty about its real-world performance. One recent study demonstrated that commercial CPOE systems can effectively prevent adverse drug events (ADEs) in community hospitals. This follow-up study sought to establish the business case for CPOE through calculating the hospitals' return on investment (ROI)—accounting for the costs saved by preventing ADEs in relation to the cost of buying and implementing the system. Perhaps the study's greatest utility is that it provides data on the actual implementation costs of CPOE in the community setting, but the ROI for hospitals was modest at best and was actually negative at some hospitals. The authors note that the CPOE system in question had minimal decision support capabilities and even a small increase in ADE prevention via decision support would have improved the ROI. Findings from this study demonstrate that economic evaluation of safety strategies is urgently needed.