Value and Patient Safety

Last Updated: March 13, 2023

Created By: Lorri Zipperer, Cybrarian, AHRQ PSNet Team

Description

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.

Library Organization

Custom - This library is organized by custom section header names.

Foundations (8)

Strengthening the Business Case for Patient Safety

Peter K. Lindenauer, MD, MSc |

May 1, 2013

This piece discusses efforts to promote the business case for safety and quality in health care.

Making the business case for patient safety.

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

Classic

Nurse staffing in hospitals: is there a business case for quality?

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... Read More

Improvement initiatives (6)

Intravenous infusion safety technology: return on investment.

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.

Classic

The business case for quality: economic analysis of the Michigan Keystone Patient Safety Program in ICUs.

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... Read More

Developing a high value care programme from the bottom up: a programme of faculty-resident improvement projects targeting harmful or unnecessary care.

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... Read More

Measurement (8)

Comparative economic analyses of patient safety improvement strategies in acute care: a systematic review.

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... Read More

Economic measurement of medical errors using a hospital claims database.

David G, Gunnarsson CL, Waters HC, et al. Value Health. 2013;16:305-10.

This study used actuarial methods to conclude that each preventable adverse event costs hospitals approximately $900, in contrast to another recent study that demonstrated that... Read More

Return on investment for vendor computerized physician order entry in four community hospitals: the importance of decision support.

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... Read More

Patient Engagement (1)

Partnering with Patients to Drive Shared Decisions, Better Value, and Care Improvement—Workshop Proceedings.

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... Read More

All Library Content (23)

Review

Comparative economic analyses of patient safety improvement strategies in acute care: a systematic review.

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.

Study

Classic

The business case for quality: economic analysis of the Michigan Keystone Patient Safety Program in ICUs.

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.

Study

Classic

Nurse staffing in hospitals: is there a business case for quality?

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.

Value and Patient Safety

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