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Value and Patient Safety

Last Updated: March 13, 2023
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 (23)
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Etchells E, Koo M, Daneman N, et al. BMJ Qual Saf. 2012;21:448-56.
Progress has been achieved in several areas of patient safety, but the cost-effectiveness of successful interventions remains an important question for policymakers and organizational leadership. This systematic review evaluated the cost-effectiveness of interventions to address 15 key safety targets (including health care–associated infections, adverse drug events, retained foreign bodies after surgery, and wrong-site surgery), but identified only 7 methodologically adequate economic analyses. Based on this limited dataset, the authors identified 4 cost-effective safety interventions, including checklists to prevent catheter-related bloodstream infections and medication reconciliation conducted by pharmacists. More robust economic analyses will be required in order to help prioritize safety interventions in the future.
Waters HR, Korn R, Colantuoni E, et al. Am J Med Qual. 2011;26:333-339.
One of the seminal achievements in the patient safety field, the Keystone ICU project accomplished impressive short-term and long-term reductions in health care–associated infections in Michigan ICUs by implementing checklists and improving safety culture. This follow-up study also demonstrates the cost-effectiveness of the program, as the money saved by preventing infections greatly outweighed the cost of the intervention itself. Substantiating the business case for quality in this fashion will further stimulate wide dissemination of proven safety interventions.
Needleman J, Buerhaus P, Stewart M, et al. Health Aff (Millwood). 2006;25:204-11.
The relationship between nurse staffing and the quality and safety of care has been reported. This study compares three strategies of nurse staffing to determine their impact on costs, associated hospital days, adverse outcomes, and deaths. The options included raising the proportion of registered nurses (RNs) without changing total nursing hours, increasing nurse staffing, and a combination of both strategies. Although the change in proportion of RN staffing offered a cost savings, the latter option had the greatest effect on reduction of adverse outcomes and hospital days. However, the savings from these clinical improvements were not offset by the costs of staffing changes. The authors suggest that hospitals and patients likely share different perspectives on the value added by the nurse staffing options discussed, and health care payers may provide the financial incentive to address this gap.